Provider Demographics
NPI:1043788029
Name:ELLINGSON, TONYA COLE (FNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:COLE
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S CLIFF AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1032
Mailing Address - Country:US
Mailing Address - Phone:605-322-8860
Mailing Address - Fax:605-322-4801
Practice Address - Street 1:1301 S CLIFF AVE STE 610
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-8860
Practice Address - Fax:605-322-4801
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily