Provider Demographics
NPI:1538577945
Name:SELFRIDGE, TONYA R (RN, NNP-BC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:R
Last Name:SELFRIDGE
Suffix:
Gender:F
Credentials:RN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 TULLIE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1711 TULLIE CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2305
Practice Address - Country:US
Practice Address - Phone:404-785-7283
Practice Address - Fax:404-785-6233
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134676363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care