Provider Demographics
NPI:1174111579
Name:CAMPBELL, TONYA (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 S BYRNE RD # 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-5323
Mailing Address - Country:US
Mailing Address - Phone:419-467-2581
Mailing Address - Fax:
Practice Address - Street 1:3015 S BYRNE RD # 3
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5323
Practice Address - Country:US
Practice Address - Phone:419-467-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4807909253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care