Healthcare Provider Details

I. General information

NPI: 1588068472
Provider Name (Legal Business Name): ELIZABETH TOLMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9059 W LAKE PLEASANT PKWY SUITE E540
PEORIA AZ
85382-8336
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY SUITE E540
PEORIA AZ
85382-8336
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-3380
  • Fax: 623-322-4399
Mailing address:
  • Phone: 623-322-3380
  • Fax: 623-322-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5819
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: