Provider Demographics
NPI:1770632952
Name:SANCHEZ, THOMAS A I (FNP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:SANCHEZ
Suffix:I
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SHELDON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4234
Mailing Address - Country:US
Mailing Address - Phone:616-988-8774
Mailing Address - Fax:616-988-8775
Practice Address - Street 1:72 SHELDON BLVD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4234
Practice Address - Country:US
Practice Address - Phone:616-988-8774
Practice Address - Fax:616-988-8775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704148377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily