Healthcare Provider Details

I. General information

NPI: 1134846231
Provider Name (Legal Business Name): AUSTIN SAMUEL THOMAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 S MCCLINTOCK DR STE 302
TEMPE AZ
85282-5879
US

IV. Provider business mailing address

4041 S MCCLINTOCK DR STE 302
TEMPE AZ
85282-5879
US

V. Phone/Fax

Practice location:
  • Phone: 520-233-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number9511506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: