Provider Demographics
NPI:1497633945
Name:DENNIS, TYESIA S
Entity type:Individual
Prefix:
First Name:TYESIA
Middle Name:S
Last Name:DENNIS
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 1:7730 PLANTATION BAY DR APT 306
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5194
Mailing Address - Country:US
Mailing Address - Phone:904-226-4646
Mailing Address - Fax:
Practice Address - Street 1:7730 PLANTATION BAY DR APT 306
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5194
Practice Address - Country:US
Practice Address - Phone:904-343-6349
Practice Address - Fax:904-343-6349
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA-297164372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion