Provider Demographics
NPI:1902523764
Name:REID, TONJA YVETTE
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:YVETTE
Last Name:REID
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 1:2015 56TH AVE S APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5039
Mailing Address - Country:US
Mailing Address - Phone:727-262-9117
Mailing Address - Fax:
Practice Address - Street 1:10 GREENRIDGE ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7524
Practice Address - Country:US
Practice Address - Phone:727-262-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty