Provider Demographics
NPI:1972736676
Name:MCMILLON, TONYA GERMANY
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:GERMANY
Last Name:MCMILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 DR. LASALLE LAFFALLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351
Mailing Address - Country:US
Mailing Address - Phone:850-539-2888
Mailing Address - Fax:850-539-2766
Practice Address - Street 1:278 DR. LASALLE LAFFALLE DRIVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-1000
Practice Address - Country:US
Practice Address - Phone:850-539-2888
Practice Address - Fax:850-539-2766
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5168561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse