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General NPI Number Information
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NPI Number | 1104254952
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Entity Type | Individual
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Provider Name | TONYA ALLEN I NP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 3269 STOCKTON HILL RD
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City | KINGMAN
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State | AZ
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Zip | 86409-3619
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Country | US
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Telephone | 928-757-0645
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Fax | 386-274-7801
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Provider Business Mailing Address
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Address Line | PO BOX 11577
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City | DAYTONA BEACH
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State | FL
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Zip | 32120-1577
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Country | US
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Telephone | 386-274-7800
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Fax | 386-274-7801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP5238
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License Number State | AZ
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