Provider Demographics
NPI:1518361658
Name:THEROUX, THOMAS (FNP-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:THEROUX
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK VISTA DR UNIT 3014
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-3032
Mailing Address - Country:US
Mailing Address - Phone:732-948-1598
Mailing Address - Fax:
Practice Address - Street 1:3041 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7447
Practice Address - Country:US
Practice Address - Phone:702-473-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner