Provider Demographics
NPI:1457558512
Name:KRANTZ, TONYA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:C
Last Name:KRANTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4605
Mailing Address - Country:US
Mailing Address - Phone:931-552-8012
Mailing Address - Fax:931-551-3118
Practice Address - Street 1:1822 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4605
Practice Address - Country:US
Practice Address - Phone:931-552-8012
Practice Address - Fax:931-551-3118
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728817Medicaid
TN4102314OtherBLUE CROSS BLUE SHIELD
TN3728817Medicaid
TNS00334Medicare UPIN