Provider Demographics
NPI:1790705838
Name:DAVIS, TONYA SUE (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:SUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1904 HIGHWAY 46 S STE 3
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-7745
Mailing Address - Country:US
Mailing Address - Phone:615-441-6000
Mailing Address - Fax:615-375-8469
Practice Address - Street 1:1904 HIGHWAY 46 S STE 3
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7745
Practice Address - Country:US
Practice Address - Phone:615-441-6000
Practice Address - Fax:615-375-8469
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ72209Medicare UPIN