Provider Demographics
NPI:1528580974
Name:TOME, GINA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:TOME
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 W GRAN PARADISO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2177
Mailing Address - Country:US
Mailing Address - Phone:480-748-7788
Mailing Address - Fax:
Practice Address - Street 1:6320 W UNION HILLS DR STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7239
Practice Address - Country:US
Practice Address - Phone:480-619-4097
Practice Address - Fax:480-619-4098
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily