Provider Demographics
NPI:1265451926
Name:SELLERS, TONYA (ACNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:6 RICHLAND MEDICAL PARK DR STE 2100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6864
Practice Address - Country:US
Practice Address - Phone:803-434-2762
Practice Address - Fax:803-434-2713
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1485363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0722Medicaid
SCNP0722Medicaid
SCP13890Medicare UPIN