Basic Information
Provider Information
NPI: 1245428382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITE
FirstName: TONYA
MiddleName: YOUNG
NamePrefix: MRS.
NameSuffix:  
Credential: NNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7703 FLOYD CURL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293901
CountryCode: US
TelephoneNumber: 2102571400
FaxNumber: 2102571428
Practice Location
Address1: 333 N SANTA ROSA
Address2: 1ST FLOOR
City: SAN ANTONIO
State: TX
PostalCode: 782073108
CountryCode: US
TelephoneNumber: 2107042335
FaxNumber: 2107042772
Other Information
ProviderEnumerationDate: 10/12/2007
LastUpdateDate: 04/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LN0000X651872TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal

No ID Information.


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