Healthcare Provider Details

I. General information

NPI: 1003560095
Provider Name (Legal Business Name): TONYA SIMONE SEABROOK-SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONYA SIMONE SEABROOK CERTIFIED NURSE AIDE

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 CLATTY FARM RD
RUFFIN SC
29475-5186
US

IV. Provider business mailing address

285 CLATTY FARM RD
RUFFIN SC
29475-5186
US

V. Phone/Fax

Practice location:
  • Phone: 813-763-7985
  • Fax:
Mailing address:
  • Phone: 813-763-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number119416
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: