Provider Demographics
NPI:1952416455
Name:HART, TONYA FELICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:FELICIA
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 OTTERS DEN CT E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-5117
Mailing Address - Country:US
Mailing Address - Phone:803-318-3007
Mailing Address - Fax:
Practice Address - Street 1:MALCOM RANDALL VA MEDICAL CENTER
Practice Address - Street 2:1601 S.W. ARCHER ROAD
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1197
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0071091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952416455OtherNPI