Provider Demographics
NPI:1033601067
Name:TOMAS, AMILA (DNP, AGNP-C)
Entity Type:Individual
Prefix:DR
First Name:AMILA
Middle Name:
Last Name:TOMAS
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 SOUTHFORK ROAD
Mailing Address - Street 2:SUITE 200/220
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3206
Mailing Address - Country:US
Mailing Address - Phone:314-543-5942
Mailing Address - Fax:
Practice Address - Street 1:12700 SOUTHFORK ROAD
Practice Address - Street 2:SUITE 200/220
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-543-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018006140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner