Provider Demographics
NPI:1922716232
Name:THOMAS, TIANA SUMMER
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:SUMMER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 LODGEPOLE CIR
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9576
Mailing Address - Country:US
Mailing Address - Phone:970-366-8836
Mailing Address - Fax:
Practice Address - Street 1:328 LODGEPOLE CIR
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9576
Practice Address - Country:US
Practice Address - Phone:970-366-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO013020641172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver