Provider Demographics
NPI:1336790021
Name:THOMMEN, HALEY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ANN
Last Name:THOMMEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:ANN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:226 SCHILLING CIR STE 170
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8641
Mailing Address - Country:US
Mailing Address - Phone:410-448-6400
Mailing Address - Fax:410-785-4840
Practice Address - Street 1:226 SCHILLING CIR STE 170
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-8641
Practice Address - Country:US
Practice Address - Phone:410-448-6400
Practice Address - Fax:410-785-4840
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363A00000X
MDC0007374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant