Provider Demographics
NPI:1366270472
Name:HYATT, TONYA N (HOME HEALTH CARE)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:N
Last Name:HYATT
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:NICOLE
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME HEALTH CARE
Mailing Address - Street 1:5218 JAMMES RD STE D3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7700
Mailing Address - Country:US
Mailing Address - Phone:904-655-3786
Mailing Address - Fax:
Practice Address - Street 1:5218 JAMMES RD STE D3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7700
Practice Address - Country:US
Practice Address - Phone:904-655-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide