Provider Demographics
NPI:1427433671
Name:SHELL, TONJA RENE (FNP-BC, ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:TONJA
Middle Name:RENE
Last Name:SHELL
Suffix:
Gender:F
Credentials:FNP-BC, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25447
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-5447
Mailing Address - Country:US
Mailing Address - Phone:336-765-9328
Mailing Address - Fax:336-768-5762
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-765-9328
Practice Address - Fax:336-768-5762
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007829363LF0000X, 363LA2100X
NC176746163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care