Healthcare Provider Details

I. General information

NPI: 1356911192
Provider Name (Legal Business Name): TONYA AILEEN REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 MILLBROOK CIR
FOUNTAIN CO
80817-1324
US

IV. Provider business mailing address

6816 MILLBROOK CIR
FOUNTAIN CO
80817-1324
US

V. Phone/Fax

Practice location:
  • Phone: 719-502-5765
  • Fax:
Mailing address:
  • Phone: 719-502-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNA.00711640
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: