Provider Demographics
NPI:1578648424
Name:CORNATZER, TONA F (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TONA
Middle Name:F
Last Name:CORNATZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:265 HOWARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-7237
Mailing Address - Country:US
Mailing Address - Phone:336-940-2481
Mailing Address - Fax:336-753-1670
Practice Address - Street 1:210 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2039
Practice Address - Country:US
Practice Address - Phone:336-753-6750
Practice Address - Fax:336-753-1670
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102533363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10185OtherNORTH CAROLINA BOARD OF PHARMACY (NCBOP)
NC102533OtherNC MEDICAL BOARD LICENSE
1035311OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
NC1578648424Medicaid
NC1578648424Medicaid
1035311OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)