Provider Demographics
NPI:1932928488
Name:VASQUEZ, TONJA L (LPN)
Entity type:Individual
Prefix:
First Name:TONJA
Middle Name:L
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 JEFFERSON DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3148
Mailing Address - Country:US
Mailing Address - Phone:270-836-1437
Mailing Address - Fax:
Practice Address - Street 1:802 JEFFERSON DAVIS DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3148
Practice Address - Country:US
Practice Address - Phone:270-836-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 221700000X, 172A00000X, 251B00000X, 174200000X, 251J00000X, 261QA0600X, 302R00000X, 343900000X, 347C00000X, 372500000X, 372600000X, 374U00000X, 376J00000X
KY2025402164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No172A00000XOther Service ProvidersDriver
No251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
No251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker