Provider Demographics
NPI:1376219667
Name:HOLMES, TYNIKA DANELL
Entity Type:Individual
Prefix:MS
First Name:TYNIKA
Middle Name:DANELL
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 1:6033 DE ZAVALA RD APT 2118
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2260
Mailing Address - Country:US
Mailing Address - Phone:210-214-0211
Mailing Address - Fax:
Practice Address - Street 1:6033 DE ZAVALA RD APT 2118
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2260
Practice Address - Country:US
Practice Address - Phone:210-214-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647452278C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical CareGroup - Single Specialty