Provider Demographics
NPI:1346809407
Name:BOSCH, TONYA LEEANN (BSN RN PHN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LEEANN
Last Name:BOSCH
Suffix:
Gender:F
Credentials:BSN RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N A ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3516
Mailing Address - Country:US
Mailing Address - Phone:805-742-3301
Mailing Address - Fax:
Practice Address - Street 1:4038 CONSTELLATION RD
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1413
Practice Address - Country:US
Practice Address - Phone:724-713-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN613745163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool