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NPI Code Detail

MEDICARE: TONYA R SELFRIDGE RN, NNP-BC

MEDICARE: TONYA R SELFRIDGE RN, NNP-BC
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
1363LN0005XCritical Care Neonatal Nurse PractitionerRN134676GA

General Provider Information

NPI Number : 1538577945
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA R SELFRIDGE RN, NNP-BC
Provider Business Mailing Address
First Line : 1711 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1711 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2305
Country : US
Telephone Number : 404-785-7283
Fax Number : 404-785-6233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 11/07/2014

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