Provider Demographics
NPI:1952908139
Name:TORNGA, ERIC THOMAS (FNP-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:TORNGA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9396
Mailing Address - Country:US
Mailing Address - Phone:616-895-2000
Mailing Address - Fax:
Practice Address - Street 1:11315 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9396
Practice Address - Country:US
Practice Address - Phone:616-895-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300367NSA200NL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily