Provider Demographics
NPI:1104270735
Name:REYES, TONYA M (MSN, FNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N BELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1120
Mailing Address - Country:US
Mailing Address - Phone:423-254-1130
Mailing Address - Fax:423-254-1762
Practice Address - Street 1:305 N BELLWOOD RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1120
Practice Address - Country:US
Practice Address - Phone:423-254-1130
Practice Address - Fax:423-254-1762
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20908363LX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021481Medicaid