Active NPI
Tonya Lynn Larson, NP
- Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1124560768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5007
- Practice address
- 4730 Chicago Ave
Minneapolis, MN 55407-3570 - Phone
- (952) 883-6805
- NPI assigned
- Nov 14, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5007 | MN | Primary |
Addresses
Primary practice location
4730 Chicago Ave
Minneapolis, MN 55407-3570
Mailing address
8170 33Rd Ave S
Bloomington, MN 55425-4516
Phone (952) 883-6805
Other practice location 1
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240423002681 | MN | Order and Referring Only - Nurse Practitioner | 7214297308 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5007 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595894400000",
"number": "1124560768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554254516",
"telephone_number": "952-883-6805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4730 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073570",
"telephone_number": "952-883-6805"
}
],
"practiceLocations": [
{
"address_1": "909 Fulton St SE",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "554554800",
"country_code": "US",
"telephone_number": "612-672-7422",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LARSON",
"first_name": "TONYA",
"middle_name": "LYNN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-14",
"last_updated": "2020-07-28",
"certification_date": "2020-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "5007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.