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Organization

AZ AT HOME INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS ALAN GREEN FNP-BC (CEO)
(480) 275-2022
Entity
Organization

Contact information

Practice address
12630 N 103RD AVE STE 142, SUN CITY, AZ 85351-3463
(480) 275-2022
(888) 551-6092
Mailing address
12630 N 103RD AVE STE 142, SUN CITY, AZ 85351-3463
(480) 275-2022
(888) 551-6092

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN078764
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
031189
AZ
05
769044
AZ
Enumeration date
07/04/2015
Last updated
02/08/2022
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