Provider Demographics
NPI:1568248656
Name:NICHOLSON-QUILLIN, TONYA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:NICHOLSON-QUILLIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48462 BELL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9625
Mailing Address - Country:US
Mailing Address - Phone:724-773-1995
Mailing Address - Fax:
Practice Address - Street 1:48462 BELL SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9625
Practice Address - Country:US
Practice Address - Phone:724-773-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034831363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner