Provider Demographics
NPI:1417342908
Name:MITCHELL, TYNEZA
Entity Type:Individual
Prefix:
First Name:TYNEZA
Middle Name:
Last Name:MITCHELL
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 1:7623 LOUETTA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7237
Mailing Address - Country:US
Mailing Address - Phone:328-968-8090
Mailing Address - Fax:832-968-8091
Practice Address - Street 1:7623 LOUETTA RD STE 104
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7237
Practice Address - Country:US
Practice Address - Phone:832-968-8090
Practice Address - Fax:832-968-8091
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily