Provider Demographics
NPI:1093608457
Name:REAGAN, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4036
Mailing Address - Country:US
Mailing Address - Phone:931-200-3058
Mailing Address - Fax:931-200-3058
Practice Address - Street 1:236 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4036
Practice Address - Country:US
Practice Address - Phone:931-200-3058
Practice Address - Fax:931-200-3058
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ102322Medicaid