Provider Demographics
NPI:1619155082
Name:DAVIS, TONYA GAYLE (LVN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:GAYLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:GAYLE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2401 WHITE STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3163
Mailing Address - Country:US
Mailing Address - Phone:806-220-6713
Mailing Address - Fax:
Practice Address - Street 1:2401 WHITE STALLION WAY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3163
Practice Address - Country:US
Practice Address - Phone:806-220-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179903164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse