Healthcare Provider Details

I. General information

NPI: 1760605489
Provider Name (Legal Business Name): TONYA R. MORAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 70 E STE 102
DICKSON TN
37055-2080
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 209
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 615-375-1531
  • Fax: 615-375-1526
Mailing address:
  • Phone: 615-441-4478
  • Fax: 615-446-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147581
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17773
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: