Provider Demographics
NPI:1639253057
Name:POWELL, TONYA KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:KAY
Last Name:POWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 BAYOU BLVD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-477-9253
Mailing Address - Fax:850-494-9843
Practice Address - Street 1:4700 BAYOU BLVD.
Practice Address - Street 2:SUITE 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-477-9253
Practice Address - Fax:850-494-9843
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3195902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307817500Medicaid
FLU3545AMedicare ID - Type Unspecified