Provider Demographics
NPI:1356911192
Name:REYNOLDS, TONYA AILEEN
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:AILEEN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 MILLBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1324
Mailing Address - Country:US
Mailing Address - Phone:719-502-5765
Mailing Address - Fax:
Practice Address - Street 1:6816 MILLBROOK CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1324
Practice Address - Country:US
Practice Address - Phone:719-502-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.00711640376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide