Provider Demographics
NPI:1770129280
Name:JEFFERSON, THOMAS TYRONE
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:TYRONE
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 HOLLOW FALLS CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-7739
Mailing Address - Country:US
Mailing Address - Phone:214-675-5948
Mailing Address - Fax:
Practice Address - Street 1:1860 HOLLOW FALLS CT
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-7739
Practice Address - Country:US
Practice Address - Phone:214-675-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty