Provider Demographics
NPI:1326608043
Name:TYNES, ERICA N
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:N
Last Name:TYNES
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 1:6370 AMBLESIDE DR APT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1994
Mailing Address - Country:US
Mailing Address - Phone:614-302-2289
Mailing Address - Fax:
Practice Address - Street 1:6370 AMBLESIDE DR APT C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1994
Practice Address - Country:US
Practice Address - Phone:614-302-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist