Provider Demographics
NPI:1225213549
Name:BARRETT, TONYA
Entity Type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:
Last Name:BARRETT
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 1:224 RUGBY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1140
Mailing Address - Country:US
Mailing Address - Phone:585-317-5237
Mailing Address - Fax:
Practice Address - Street 1:319 CEDAR TER
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1439
Practice Address - Country:US
Practice Address - Phone:585-802-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251316-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02189779Medicaid