Provider Demographics
NPI:1265114037
Name:THURBER, PATRICK DONALD (APRN)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DONALD
Last Name:THURBER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1919
Mailing Address - Country:US
Mailing Address - Phone:520-364-3285
Mailing Address - Fax:
Practice Address - Street 1:77 CALLE PORTAL STE C240
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2986
Practice Address - Country:US
Practice Address - Phone:520-354-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2022139997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health