Provider Demographics
NPI:1801468749
Name:PUTT, TONYA BETH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:BETH
Last Name:PUTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 SIR THOMAS CT FL 1
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-988-0020
Mailing Address - Fax:717-703-5746
Practice Address - Street 1:805 SIR THOMAS CT FL 1
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-988-0020
Practice Address - Fax:717-703-5746
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP023935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily