Provider Demographics
NPI:1215546866
Name:TINDAL-BROOKS, DENITRA
Entity Type:Individual
Prefix:
First Name:DENITRA
Middle Name:
Last Name:TINDAL-BROOKS
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 1:4564 WRANGLER TRL
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-9783
Mailing Address - Country:US
Mailing Address - Phone:803-665-4484
Mailing Address - Fax:
Practice Address - Street 1:4564 WRANGLER TRL
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-9783
Practice Address - Country:US
Practice Address - Phone:803-665-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide