Provider Demographics
NPI:1366488744
Name:THIES, JOYCE F (PA)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:F
Last Name:THIES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38240 DAUGHTERY RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1367
Mailing Address - Country:US
Mailing Address - Phone:813-788-3582
Mailing Address - Fax:813-780-6707
Practice Address - Street 1:38240 DAUGHTERY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1367
Practice Address - Country:US
Practice Address - Phone:813-788-3582
Practice Address - Fax:813-780-6707
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970024231OtherRAILROAD MEDICARE
FL291351800Medicaid
970024231OtherRAILROAD MEDICARE
FLE6961YMedicare PIN
FL291351800Medicaid