Provider Demographics
NPI:1326632290
Name:DRAKE, TONYA R
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:R
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:VINCENT
Other - Middle Name:K
Other - Last Name:DRAKE
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 WALTER SHAW RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:NC
Mailing Address - Zip Code:28438-9641
Mailing Address - Country:US
Mailing Address - Phone:504-376-7969
Mailing Address - Fax:
Practice Address - Street 1:123 WALTER SHAW RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:NC
Practice Address - Zip Code:28438-9641
Practice Address - Country:US
Practice Address - Phone:504-376-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3497376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator