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NPI Code Detail

MEDICARE: JONATHAN JOSEPH TANSILL PA-C

MEDICARE:   JONATHAN JOSEPH TANSILL  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant9911AZ

General Provider Information

NPI Number : 1417638552
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN JOSEPH TANSILL PA-C
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-1213
Fax Number : 602-933-1214
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-1213
Fax Number : 602-933-1214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2023
Last Update Date : 02/10/2026

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Directions to “ JONATHAN JOSEPH TANSILL PA-C” Practice Location

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