Provider Demographics
NPI:1316355977
Name:HEREDIA, TONYA MARIE (RN00136279)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:MARIE
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:RN00136279
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 704 BOX 3783
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-0018
Mailing Address - Country:US
Mailing Address - Phone:360-200-0977
Mailing Address - Fax:
Practice Address - Street 1:MCJA-NUR UNIT 45011
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:315-263-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00136279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse