Provider Demographics
NPI:1134562382
Name:ETEO, TONYA ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:ELIZABETH
Last Name:ETEO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700A PROGRESS PL
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5545
Mailing Address - Country:US
Mailing Address - Phone:910-276-6767
Mailing Address - Fax:910-276-7877
Practice Address - Street 1:700A PROGRESS PL
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5545
Practice Address - Country:US
Practice Address - Phone:910-276-6767
Practice Address - Fax:910-276-7877
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004204363LF0000X
NC139256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2427Medicaid
NC1134562382Medicaid
NC1134562382Medicaid