Provider Demographics
NPI:1467050724
Name:ARNOLD, TYNESHIA (CNA)
Entity Type:Individual
Prefix:
First Name:TYNESHIA
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 BAILEY ST APT K3
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1859
Mailing Address - Country:US
Mailing Address - Phone:706-351-2775
Mailing Address - Fax:
Practice Address - Street 1:288 BAILEY ST APT K3
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1859
Practice Address - Country:US
Practice Address - Phone:706-351-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030060233172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker