Provider Demographics
NPI:1669667168
Name:TOMKUS, GINA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:C
Last Name:TOMKUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 N PINAL PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-9459
Mailing Address - Country:US
Mailing Address - Phone:520-868-2049
Mailing Address - Fax:520-868-1547
Practice Address - Street 1:3250 N PINAL PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-9459
Practice Address - Country:US
Practice Address - Phone:520-868-2049
Practice Address - Fax:520-868-1547
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ960531133V00000X
AZ6322363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered