Provider Demographics
NPI:1912706789
Name:CARPENTER, TONYA (LPN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 S ARLINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2061
Mailing Address - Country:US
Mailing Address - Phone:216-202-5621
Mailing Address - Fax:
Practice Address - Street 1:2656 S ARLINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-2061
Practice Address - Country:US
Practice Address - Phone:216-202-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM823669172A00000X
OH137726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172A00000XOther Service ProvidersDriver