Provider Demographics
NPI:1558140475
Name:OSBORN, TONYA COLLEEN (PRSS)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:COLLEEN
Last Name:OSBORN
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 PASEO HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3074
Mailing Address - Country:US
Mailing Address - Phone:720-649-7404
Mailing Address - Fax:
Practice Address - Street 1:2290 MCDANIEL ST STE 1B
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6330
Practice Address - Country:US
Practice Address - Phone:702-899-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCAPRC2-5172175T00000X
NVPRSS-5195175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist