Provider Demographics
NPI:1801327507
Name:SCOTT, TONYA (NP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:20415 CIVIC CENTER DR
Mailing Address - Street 2:SUIT# 355
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-353-6200
Mailing Address - Fax:248-353-7366
Practice Address - Street 1:21415 CIVIC CENTER DR
Practice Address - Street 2:#355
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3909
Practice Address - Country:US
Practice Address - Phone:248-353-6200
Practice Address - Fax:248-353-7366
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205624363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology