Healthcare Provider Details

I. General information

NPI: 1457085565
Provider Name (Legal Business Name): TATUM THOMAS KOMENDA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TATUM THOMAS

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 200
GILBERT AZ
85297-0423
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 480-909-3788
  • Fax: 480-728-8191
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10067
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10067
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: