Provider Demographics
NPI:1982571907
Name:GRIJALVA, THOMAS JOHN (MSN-FNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:GRIJALVA
Suffix:
Gender:M
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S AVENUE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2749
Mailing Address - Country:US
Mailing Address - Phone:928-539-3140
Mailing Address - Fax:928-539-5579
Practice Address - Street 1:675 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2749
Practice Address - Country:US
Practice Address - Phone:928-539-3140
Practice Address - Fax:928-539-5579
Is Sole Proprietor?:No
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223018363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care