Provider Demographics
NPI:1275288839
Name:THOMAS, REISA INOSANTO (NP)
Entity Type:Individual
Prefix:
First Name:REISA
Middle Name:INOSANTO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REISA
Other - Middle Name:FLORES
Other - Last Name:INOSANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3857 PEACHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2633
Mailing Address - Country:US
Mailing Address - Phone:808-741-3734
Mailing Address - Fax:
Practice Address - Street 1:8116 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1015
Practice Address - Country:US
Practice Address - Phone:702-407-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3396363LF0000X
NV856373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily