Provider Demographics
NPI:1255654083
Name:JENNINGS, TONYA RENEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RENEE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:PANKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:518 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1100
Mailing Address - Country:US
Mailing Address - Phone:615-597-4005
Mailing Address - Fax:615-597-6667
Practice Address - Street 1:518C WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166
Practice Address - Country:US
Practice Address - Phone:615-597-4005
Practice Address - Fax:615-597-6667
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN150508163W00000X
TNF0414250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF0414250OtherAANP
TNQ011372Medicaid