Provider Demographics
NPI:1467585950
Name:SMITH, TONYA MARIA (STNA)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:MARIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1822 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2947
Mailing Address - Country:US
Mailing Address - Phone:614-251-0979
Mailing Address - Fax:
Practice Address - Street 1:1822 SURREY PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2947
Practice Address - Country:US
Practice Address - Phone:614-251-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324872750901376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622415Medicaid