Provider Demographics
NPI:1629001367
Name:TINEO, YOVANNI (DO)
Entity Type:Individual
Prefix:DR
First Name:YOVANNI
Middle Name:
Last Name:TINEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:YOVANNI
Other - Middle Name:
Other - Last Name:ENMANUEL-TINEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:90 CYPRESS WAY E STE 10
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:239-592-5655
Mailing Address - Fax:239-592-1370
Practice Address - Street 1:90 CYPRESS WAY E STE 10
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-592-1248
Practice Address - Fax:239-592-1370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79339OtherBCBS
FLH89449Medicare UPIN
FL79339AMedicare ID - Type Unspecified