Provider Demographics
NPI:1295279149
Name:QUEEN, TONYA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E COUNTY ROAD 300 N
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7561
Mailing Address - Country:US
Mailing Address - Phone:812-239-8178
Mailing Address - Fax:
Practice Address - Street 1:1813 WILLOW ST STE 5A
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4279
Practice Address - Country:US
Practice Address - Phone:812-885-8945
Practice Address - Fax:812-885-8571
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006747A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily