Provider Demographics
NPI:1194115790
Name:SYNERGY HEALTHCARE PLLC
Entity type:Organization
Organization Name:SYNERGY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACITITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:612-916-0593
Mailing Address - Street 1:12100 SINGLETREE LN STE 129
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7937
Mailing Address - Country:US
Mailing Address - Phone:952-746-1256
Mailing Address - Fax:952-746-1392
Practice Address - Street 1:12100 SINGLETREE LN STE 129
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7937
Practice Address - Country:US
Practice Address - Phone:952-746-1256
Practice Address - Fax:952-746-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR158646-8261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service