Provider Demographics
NPI:1689698243
Name:THOMAS, TINA L (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9229 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:972-739-3097
Mailing Address - Fax:972-739-2673
Practice Address - Street 1:2500 W PLEASANT RUN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1170
Practice Address - Country:US
Practice Address - Phone:972-229-5280
Practice Address - Fax:972-223-7688
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX584762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166046601Medicaid
TX156007005Medicaid
TX156007006Medicaid
TX156007006Medicaid
TX8K7977Medicare UPIN
TXP77790Medicare UPIN
TX156007005Medicaid
TX166046601Medicaid