Provider Demographics
NPI:1194543181
Name:COLLINSWORTH, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:COLLINSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 COUNTY ROAD 243
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-7152
Mailing Address - Country:US
Mailing Address - Phone:713-376-0301
Mailing Address - Fax:979-849-3428
Practice Address - Street 1:933 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-5075
Practice Address - Country:US
Practice Address - Phone:713-376-0301
Practice Address - Fax:979-849-3428
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001009660251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health