Provider Demographics
NPI:1508293713
Name:NELSON, THOMAS J (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:22713 S ELLSWORTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7886
Mailing Address - Country:US
Mailing Address - Phone:480-474-5670
Mailing Address - Fax:480-987-7643
Practice Address - Street 1:22713 S ELLSWORTH RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-474-5670
Practice Address - Fax:480-987-7643
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ55492084P0800X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry