Provider Demographics
NPI:1417256637
Name:NEWSOM, TONYA L (FNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:NEWSOM
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 1:7675 WOLF RIVER CIR
Mailing Address - Street 2:CIRCLE SUITE#202
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1750
Mailing Address - Country:US
Mailing Address - Phone:901-737-3021
Mailing Address - Fax:901-521-6405
Practice Address - Street 1:7675 WOLF RIVER CIR
Practice Address - Street 2:SUITE#202
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-737-3021
Practice Address - Fax:901-521-6405
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1417256637Medicaid
MS08031269Medicaid
TNAPN0000015718OtherSTATE LICENSE
TN1528835Medicaid
MSA810396OtherSTATE LICENSE