Provider Demographics
NPI:1265559421
Name:THOMAS, BOBBI G (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:G
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 N MESA ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5462
Mailing Address - Country:US
Mailing Address - Phone:915-842-0504
Mailing Address - Fax:815-842-0448
Practice Address - Street 1:1721 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4521
Practice Address - Country:US
Practice Address - Phone:915-590-9424
Practice Address - Fax:915-842-0448
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM342726901OtherCMS GROUP MEMEBER PTAN
TX248895OtherNURSING LICENSE
TX248895OtherNURSING LICENSE
NM342726901OtherCMS GROUP MEMEBER PTAN