Provider Demographics
NPI:1326822313
Name:TINSLEY, TIMOTHY (LPN SA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:M
Credentials:LPN SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12971 E HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:OCKLAWAHA
Mailing Address - State:FL
Mailing Address - Zip Code:32179-5115
Mailing Address - Country:US
Mailing Address - Phone:352-272-2694
Mailing Address - Fax:
Practice Address - Street 1:12971 E HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:OCKLAWAHA
Practice Address - State:FL
Practice Address - Zip Code:32179-5115
Practice Address - Country:US
Practice Address - Phone:352-272-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5256921208600000X, 164W00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No164W00000XNursing Service ProvidersLicensed Practical Nurse