Healthcare Provider Details

I. General information

NPI: 1538577945
Provider Name (Legal Business Name): TONYA R SELFRIDGE RN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 TULLIE CIR NE
ATLANTA GA
30329-2305
US

IV. Provider business mailing address

1711 TULLIE CIR NE
ATLANTA GA
30329-2305
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-7283
  • Fax: 404-785-6233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN134676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: