Provider Demographics
NPI:1700101078
Name:THRASHER, TAMIS J (CPNP)
Entity Type:Individual
Prefix:MS
First Name:TAMIS
Middle Name:J
Last Name:THRASHER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4706
Mailing Address - Country:US
Mailing Address - Phone:480-412-7474
Mailing Address - Fax:602-865-4507
Practice Address - Street 1:5310 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4706
Practice Address - Country:US
Practice Address - Phone:480-412-7474
Practice Address - Fax:602-865-4507
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z139820Medicare PIN
AZZ145360Medicare PIN