Provider Demographics
NPI:1124709001
Name:THOMAS, MARISSA ROSE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ROSE
Last Name:THOMAS
Suffix:
Gender:F
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 1:1120 PINEY LODGE LN APT 409
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-5514
Mailing Address - Country:US
Mailing Address - Phone:419-769-0704
Mailing Address - Fax:
Practice Address - Street 1:1188 SKYLAND DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8002
Practice Address - Country:US
Practice Address - Phone:828-339-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine