Provider Demographics
NPI:1497425136
Name:CREQUE, TONYA MARIA (BSN, MSN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIA
Last Name:CREQUE
Suffix:
Gender:F
Credentials:BSN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3905
Mailing Address - Country:US
Mailing Address - Phone:757-635-5470
Mailing Address - Fax:
Practice Address - Street 1:2697 INTERNATIONAL PKWY STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7803
Practice Address - Country:US
Practice Address - Phone:757-635-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date: