Provider Demographics
NPI:1861849457
Name:GROFF, THOMAS NOLAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:NOLAN
Last Name:GROFF
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 VETERANS PKWY APT 1434
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1980
Mailing Address - Country:US
Mailing Address - Phone:703-624-0749
Mailing Address - Fax:
Practice Address - Street 1:12007 SUNRISE VALLEY DR STE 120
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3460
Practice Address - Country:US
Practice Address - Phone:703-522-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674198-1163WG0000X
NYF339851-1363LF0000X
MDAC007554363LP0808X
VA0024189953363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily