Provider Demographics
NPI:1447738505
Name:YOUNG, TINNIE JIMMIA
Entity Type:Individual
Prefix:
First Name:TINNIE
Middle Name:JIMMIA
Last Name:YOUNG
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 1:10317 SEPTEMBER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1122
Mailing Address - Country:US
Mailing Address - Phone:513-200-6781
Mailing Address - Fax:
Practice Address - Street 1:10317 SEPTEMBER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1122
Practice Address - Country:US
Practice Address - Phone:513-200-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP211358343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)