Provider Demographics
NPI:1598585531
Name:CARROLL, TONISHA S (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TONISHA
Middle Name:S
Last Name:CARROLL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:TONISHA
Other - Middle Name:S
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3471
Mailing Address - Country:US
Mailing Address - Phone:478-929-6700
Mailing Address - Fax:
Practice Address - Street 1:100 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3471
Practice Address - Country:US
Practice Address - Phone:478-929-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN313226163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology