Provider Demographics
NPI:1942688825
Name:THRASHER, NINA L (PA-C)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:L
Last Name:THRASHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:L
Other - Last Name:COLAMARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3824 ASPEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1700
Mailing Address - Country:US
Mailing Address - Phone:412-721-5731
Mailing Address - Fax:
Practice Address - Street 1:901 45TH STREET
Practice Address - Street 2:KIMMEL BLDG
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:412-721-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9108608OtherPA STATE LICENSE