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NPI Code Detail

MEDICARE: MRS. TONYA A HARBISON NURSE PRACTITIONER

MEDICARE:  MRS. TONYA A HARBISON  NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner902791MS

General Provider Information

NPI Number : 1083181903
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TONYA A HARBISON NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 150 BURGUNDY DR
Second Line :
City : LUCEDALE
State : MS
Zip : 39452-7951
Country : US
Telephone Number : 228-219-0752
Fax Number :
Provider Business Practice Location Address
First Line : 6912 WASHINGTON AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-2133
Country : US
Telephone Number : 228-818-9191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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Directions to “ MRS. TONYA A HARBISON NURSE PRACTITIONER” Practice Location

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