Provider Demographics
NPI:1891834024
Name:THOMSON, ARIANNA LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:LEIGH
Last Name:THOMSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21724
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1724
Mailing Address - Country:US
Mailing Address - Phone:877-468-2211
Mailing Address - Fax:877-868-4888
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:877-468-2211
Practice Address - Fax:877-868-4888
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010154-1363AS0400X
NJ25MP00214300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical