Healthcare Provider Details

I. General information

NPI: 1316057714
Provider Name (Legal Business Name): THOMAS MICHAEL NAGLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W. SOUTHERN AVE STE A1
APACHE JUNCTION AZ
85120-7653
US

IV. Provider business mailing address

2550 N THUNDERBIRD CIR STE 303 NEXTCARE URGENT CARE
MESA AZ
85215-1219
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-0172
  • Fax: 480-985-0173
Mailing address:
  • Phone: 480-353-2235
  • Fax: 480-776-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10005053
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2828
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: