Healthcare Provider Details

I. General information

NPI: 1679843205
Provider Name (Legal Business Name): TONILYN HATCH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GALISTEO ST STE 8
SANTA FE NM
87505-4752
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-9870
  • Fax: 505-983-1265
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0050
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: