Provider Demographics
NPI:1326049974
Name:THOMAS, ELIZABETH MARIAN (RN, CS, FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN, CS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6249
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:ORTHOPAEDIC BLDG, 1ST FLOOR
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-784-6200
Practice Address - Fax:520-784-6249
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103599363L00000X, 163W00000X
AZAP0701363L00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ501339Medicaid
P04805Medicare UPIN
AZ501339Medicaid
AZ78173Medicare ID - Type Unspecified
AZZ78173Medicare PIN