Provider Demographics
NPI:1316423452
Name:BASQUE, TONYA N
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:N
Last Name:BASQUE
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 1:235 SW COUNTY ROAD 2344
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76681-4384
Mailing Address - Country:US
Mailing Address - Phone:903-376-9857
Mailing Address - Fax:
Practice Address - Street 1:333 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2661
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:888-803-3331
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily