Provider Demographics
NPI:1689900276
Name:SIRRINE, THOMAS JOEL (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOEL
Last Name:SIRRINE
Suffix:
Gender:M
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 1:15425 N GREENWAY HAYDEN LOOP
Mailing Address - Street 2:STE A300
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1204
Mailing Address - Country:US
Mailing Address - Phone:480-607-1124
Mailing Address - Fax:602-532-2970
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP STE A300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1204
Practice Address - Country:US
Practice Address - Phone:480-607-1124
Practice Address - Fax:480-607-5119
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4503363A00000X
AZAZ4503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical