Provider Demographics
NPI:1598298184
Name:TYNES, JENAE
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:
Last Name:TYNES
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 1:2013 N ARMISTEAD AVE
Mailing Address - Street 2:D18
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3400
Mailing Address - Country:US
Mailing Address - Phone:757-316-6719
Mailing Address - Fax:
Practice Address - Street 1:2013 N ARMISTEAD AVE
Practice Address - Street 2:D18
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3400
Practice Address - Country:US
Practice Address - Phone:757-316-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA125633374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide