Basic Information
| Provider Information | |||||||||
| NPI: | 1033601067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMAS | ||||||||
| FirstName: | AMILA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, AGNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12700 SOUTHFORK ROAD | ||||||||
| Address2: | SUITE 200/220 | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631283206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145435942 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12700 SOUTHFORK ROAD | ||||||||
| Address2: | SUITE 200/220 | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145435942 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2018006140 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.