Provider Demographics
NPI:1982581104
Name:THOMAS, TAYLOR NICHOLE TOSHIKO (NP-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICHOLE TOSHIKO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 W BELGRAVE WAY
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-2070
Mailing Address - Country:US
Mailing Address - Phone:208-916-1252
Mailing Address - Fax:
Practice Address - Street 1:4031 W BELGRAVE WAY
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-2070
Practice Address - Country:US
Practice Address - Phone:208-916-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPENDING363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner