Provider Demographics
NPI:1801382593
Name:TERVORT, THOMAS JAMES (DNP, NP-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:TERVORT
Suffix:
Gender:M
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1055 N 300 W STE 410
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3354
Mailing Address - Country:US
Mailing Address - Phone:801-616-3675
Mailing Address - Fax:385-225-9313
Practice Address - Street 1:1055 N 300 W STE 410
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3354
Practice Address - Country:US
Practice Address - Phone:801-616-3675
Practice Address - Fax:385-225-9313
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8394281-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner