Provider Demographics
NPI:1114498094
Name:TINNI, ASIA (LPN)
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:
Last Name:TINNI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 GREEN POINT LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-2419
Mailing Address - Country:US
Mailing Address - Phone:757-448-0140
Mailing Address - Fax:
Practice Address - Street 1:127 GREEN POINT LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-2419
Practice Address - Country:US
Practice Address - Phone:757-448-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002091136164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse