Provider Demographics
NPI:1235562083
Name:THOMAS, MICHELLE CALPE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CALPE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CALPE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, PA-C
Mailing Address - Street 1:1555 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5831
Mailing Address - Country:US
Mailing Address - Phone:520-321-9850
Mailing Address - Fax:520-321-9005
Practice Address - Street 1:1555 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5831
Practice Address - Country:US
Practice Address - Phone:520-661-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0538171100000X
AZ6449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist