Healthcare Provider Details

I. General information

NPI: 1003770918
Provider Name (Legal Business Name): ERICA THORNE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W BASELINE RD
MESA AZ
85210-6041
US

IV. Provider business mailing address

612 W BASELINE RD
MESA AZ
85210-6041
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-9039
  • Fax: 480-964-7802
Mailing address:
  • Phone: 480-834-9039
  • Fax: 480-964-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: