Provider Demographics
NPI:1740286103
Name:DARR, TONYA (NP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:DARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N EDWARDSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1334
Mailing Address - Country:US
Mailing Address - Phone:618-635-3800
Mailing Address - Fax:618-635-3952
Practice Address - Street 1:444 N EDWARDSVILLE ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1334
Practice Address - Country:US
Practice Address - Phone:618-635-3800
Practice Address - Fax:619-635-3952
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP40167Medicare UPIN