Provider Demographics
NPI:1659703064
Name:FENZL, TONYA S (CNM)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:S
Last Name:FENZL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:S
Other - Last Name:BURROUGHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:727-316-6210
Mailing Address - Fax:
Practice Address - Street 1:2043 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4421
Practice Address - Country:US
Practice Address - Phone:727-846-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9489996367A00000X
OHRN393909367A00000X
IN71014602A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOA244OtherMEDICARE HF
FL115505700Medicaid