Provider Demographics
NPI:1528490109
Name:CARTER, TONYA (RN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN
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 356
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-0356
Mailing Address - Country:US
Mailing Address - Phone:804-689-0105
Mailing Address - Fax:
Practice Address - Street 1:4500 WILLOWDALE CT
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-1715
Practice Address - Country:US
Practice Address - Phone:804-689-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001240060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse