MEDICARE: MRS. TONA L TEDDER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	887	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00906620	OTHER	SC	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346235421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONA L TEDDER FNP

Provider Business Mailing Address
First Line	:	1268 SOUTH FOURTH STREET SUITE A
Second Line	:	CARESOUTH CAROLINA, INC.
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4311
Country	:	US
Telephone Number	:	843-332-3422
Fax Number	:	843-332-3985

Provider Business Practice Location Address
First Line	:	1268 SOUTH FOURTH ST SUITE A
Second Line	:	CARESOUTH CAROLINA, INC.
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4311
Country	:	US
Telephone Number	:	843-332-3422
Fax Number	:	843-332-3985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	09/01/2017

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