Provider Demographics
NPI:1275705725
Name:NORMAN, TONJA SIMMONS (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:SIMMONS
Last Name:NORMAN
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 UNION RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2214
Mailing Address - Country:US
Mailing Address - Phone:704-810-7418
Mailing Address - Fax:704-810-6560
Practice Address - Street 1:1558 UNION RD
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2214
Practice Address - Country:US
Practice Address - Phone:704-810-7418
Practice Address - Fax:704-810-6560
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003959363LF0000X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004155Medicaid
NC2593209AMedicare PIN