Provider Demographics
NPI:1043954613
Name:HINES, TANISHA
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 NW 13TH ST # 226
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2835
Mailing Address - Country:US
Mailing Address - Phone:352-415-5128
Mailing Address - Fax:
Practice Address - Street 1:7001 NW 4TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1679
Practice Address - Country:US
Practice Address - Phone:888-619-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH5208165280172A00000X
174200000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals