Provider Demographics
NPI:1881646784
Name:WEIDMAN, TONYA CAULEY (PA)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:CAULEY
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:N
Other - Last Name:CAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-410-5437
Mailing Address - Fax:251-434-3802
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 1N
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-410-5437
Practice Address - Fax:251-434-3802
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936449Medicaid
MS09935828Medicaid
FL292367000Medicaid
AL51533013OtherBCBS
MS09935828Medicaid
FL292367000Medicaid