Provider Demographics
NPI:1851934079
Name:TINNEL, MARY RYAN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RYAN
Last Name:TINNEL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 W BUCCANEER DR
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-7927
Mailing Address - Country:US
Mailing Address - Phone:907-947-3184
Mailing Address - Fax:409-982-3641
Practice Address - Street 1:1946 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2762
Practice Address - Country:US
Practice Address - Phone:409-982-0082
Practice Address - Fax:409-982-3641
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX872789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner