Provider Demographics
NPI:1346235421
Name:TEDDER, TONA L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TONA
Middle Name:L
Last Name:TEDDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 SOUTH FOURTH STREET SUITE A
Mailing Address - Street 2:CARESOUTH CAROLINA, INC.
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4311
Mailing Address - Country:US
Mailing Address - Phone:843-332-3422
Mailing Address - Fax:843-332-3985
Practice Address - Street 1:1268 SOUTH FOURTH ST SUITE A
Practice Address - Street 2:CARESOUTH CAROLINA, INC.
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4311
Practice Address - Country:US
Practice Address - Phone:843-332-3422
Practice Address - Fax:843-332-3985
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00906620OtherRAILROAD MEDICARE PTAN
SCNP1047Medicaid
SCP345474784Medicare PIN
SCSC55901850Medicare PIN
5321Medicare PIN
SCNP1047Medicaid