Provider Demographics
NPI:1316042880
Name:THOMAS, DIANE B (FNP-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:B
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2308
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:2424 N WYATT DR STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6115
Practice Address - Country:US
Practice Address - Phone:520-324-4690
Practice Address - Fax:520-324-4691
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ194745Medicaid
AZZ190894Medicare PIN