Provider Demographics
NPI:1114107513
Name:ROBERTSON, TONYA S (NP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:S
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:L
Other - Last Name:STARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 BELLEVIEW AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1838
Mailing Address - Country:US
Mailing Address - Phone:540-342-6346
Mailing Address - Fax:540-981-8681
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-342-6346
Practice Address - Fax:540-981-8681
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167532363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024167532OtherLICENSE
016153C19Medicare PIN