Provider Demographics
NPI:1285929307
Name:ROBINSON, TONYAL NICHOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TONYAL
Middle Name:NICHOLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2139
Mailing Address - Country:US
Mailing Address - Phone:315-476-0455
Mailing Address - Fax:
Practice Address - Street 1:205 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2139
Practice Address - Country:US
Practice Address - Phone:315-476-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259651-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse