Provider Demographics
NPI:1003560095
Name:SEABROOK-SUTTON, TONYA SIMONE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:SIMONE
Last Name:SEABROOK-SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:SIMONE
Other - Last Name:SEABROOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED NURSE AIDE
Mailing Address - Street 1:285 CLATTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:RUFFIN
Mailing Address - State:SC
Mailing Address - Zip Code:29475-5186
Mailing Address - Country:US
Mailing Address - Phone:813-763-7985
Mailing Address - Fax:
Practice Address - Street 1:285 CLATTY FARM RD
Practice Address - Street 2:
Practice Address - City:RUFFIN
Practice Address - State:SC
Practice Address - Zip Code:29475-5186
Practice Address - Country:US
Practice Address - Phone:813-763-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC119416376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide