Provider Demographics
NPI:1194233106
Name:THOMPSON- JONES, TALIA SIMONE (FPA APRN - BC)
Entity type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:SIMONE
Last Name:THOMPSON- JONES
Suffix:
Gender:
Credentials:FPA APRN - BC
Other - Prefix:MRS
Other - First Name:TALIA
Other - Middle Name:
Other - Last Name:THOMPSON-JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FPA APRN FNP-BC
Mailing Address - Street 1:19801 GOVERNORS HWY STE 140
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4363
Mailing Address - Country:US
Mailing Address - Phone:708-991-2945
Mailing Address - Fax:
Practice Address - Street 1:19801 GOVERNORS HWY STE 140
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4363
Practice Address - Country:US
Practice Address - Phone:708-635-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277000543OtherFULL PRESCRIPTIVE AUTHORITY LICENSE
ILF400625230Medicaid