Provider Demographics
NPI:1699075887
Name:AVERSA, TONYA LEIGH (CRNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LEIGH
Last Name:AVERSA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1124
Mailing Address - Country:US
Mailing Address - Phone:814-486-2431
Mailing Address - Fax:435-275-4093
Practice Address - Street 1:18 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT JEWETT
Practice Address - State:PA
Practice Address - Zip Code:16740-5128
Practice Address - Country:US
Practice Address - Phone:814-778-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028681740023Medicaid
NY04317988Medicaid
PA1028681740023Medicaid