Provider Demographics
NPI:1689900276
Name:SIRRINE, THOMAS JOEL (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOEL
Last Name:SIRRINE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 N TATUM BLVD STE 185
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6016
Mailing Address - Country:US
Mailing Address - Phone:602-669-2585
Mailing Address - Fax:602-669-2586
Practice Address - Street 1:11209 N TATUM BLVD STE 185
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6016
Practice Address - Country:US
Practice Address - Phone:602-669-2585
Practice Address - Fax:602-669-2586
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4503363A00000X
AZAZ4503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical