Doctor Name: | MRS. TONYA L ELLIS |
NPI Number: | 1568726289 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 16863 |
Business Practice Address: | 740 Main St Ste C Tracy City, TN - 373874020 |
Business Phone Number: | 9315929199 |
Business Fax Number: | |
Mailing Address: | 740 Main St, Ste C TRACY CITY |
State: | TN |
Postal Code: | 373874020 |
Phone Number: | 9315929199 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2012 |
NPI Last Update Date: | 02/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 16863 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |