Provider Demographics
NPI:1114222668
Name:BURNETT, TONYA M (NP-C)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N COBB ST
Mailing Address - Street 2:EMERGENCY DEPT.
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2343
Mailing Address - Country:US
Mailing Address - Phone:478-454-3795
Mailing Address - Fax:478-454-3969
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2343
Practice Address - Country:US
Practice Address - Phone:478-454-3795
Practice Address - Fax:478-454-3969
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner