Provider Demographics
NPI:1114317112
Name:HOLMES, TENNILLE
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:HOLMES
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 1:3230 SCHEIBLER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-4817
Mailing Address - Country:US
Mailing Address - Phone:901-691-1078
Mailing Address - Fax:866-278-2875
Practice Address - Street 1:3230 SCHEIBLER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-4817
Practice Address - Country:US
Practice Address - Phone:901-691-1078
Practice Address - Fax:866-278-2875
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT000397343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)