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NPI Code Detail

MEDICARE: MRS. TONYA L ELLIS FNP-BC

MEDICARE: MRS. TONYA L ELLIS FNP-BC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)16863TN
2261QH0100XHealth Service Clinic/Center16863TN
3363LF0000XFamily Nurse Practitioner16863TN

General Provider Information

NPI Number : 1568726289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TONYA L ELLIS FNP-BC
Provider Business Mailing Address
First Line : 740 MAIN ST
Second Line : STE C
City : TRACY CITY
State : TN
Zip : 37387-4020
Country : US
Telephone Number : 931-592-9199
Fax Number :
Provider Business Practice Location Address
First Line : 740 MAIN ST
Second Line : STE C
City : TRACY CITY
State : TN
Zip : 37387-4020
Country : US
Telephone Number : 931-592-9199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2012
Last Update Date : 02/13/2014

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