Provider Demographics
NPI:1760755433
Name:TATUM, SONYA B (CRNP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:B
Last Name:TATUM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MITYLENE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3547
Mailing Address - Country:US
Mailing Address - Phone:334-819-8190
Mailing Address - Fax:334-819-8195
Practice Address - Street 1:239 MITYLENE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3547
Practice Address - Country:US
Practice Address - Phone:334-819-8190
Practice Address - Fax:334-819-8195
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-073852363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health