Provider Demographics
NPI:1730646662
Name:WHITE-TINSLEY, VIRANDA D
Entity Type:Individual
Prefix:
First Name:VIRANDA
Middle Name:D
Last Name:WHITE-TINSLEY
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:PO BOX 441435
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-0014
Mailing Address - Country:US
Mailing Address - Phone:904-584-5724
Mailing Address - Fax:
Practice Address - Street 1:2044 DEAN A AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3711
Practice Address - Country:US
Practice Address - Phone:904-374-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care