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General NPI Number Information
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NPI Number | 1851587661
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Entity Type | Individual
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Provider Name | TONYA MARIE MCCULLOUGH APRN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2007
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3107 N H ST
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City | PENSACOLA
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State | FL
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Zip | 32501-1111
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Country | US
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Telephone | 850-630-6371
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Fax | 844-373-4906
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Provider Business Mailing Address
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Address Line | 2559 AVALON ST
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City | CANTONMENT
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State | FL
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Zip | 32533-8602
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Country | US
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Telephone | 850-630-6371
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Fax | 844-373-4906
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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 | ARNP2518762
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CRNP1-147420
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License Number State | AL
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