Healthcare Provider Details

I. General information

NPI: 1770297566
Provider Name (Legal Business Name): THOMAS P MATHEW FNP-C, PMHNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 S POWER RD STE 103
QUEEN CREEK AZ
85142-6068
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 480-535-0962
Mailing address:
  • Phone: 480-677-8282
  • Fax: 480-535-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number306380
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number306380
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: