Provider Demographics
NPI:1497290720
Name:TOM, JAMIE (DNP FNP-C)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:DNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740018
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0018
Mailing Address - Country:US
Mailing Address - Phone:773-759-7550
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:333 MONTANO RD NW STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5200
Practice Address - Country:US
Practice Address - Phone:505-777-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60696288363LP2300X
NM65999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care