Individual
TONJA GRINES HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
(601) 364-1357
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
(601) 364-1357
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R852026
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05484091
—
MS
Enumeration date
08/03/2011
Last updated
04/14/2016
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