Provider Demographics
NPI:1013673920
Name:VINCENZO, TINA LYNN X
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:VINCENZO
Suffix:X
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 1:1480 W 8TH ST UPPR
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3322
Mailing Address - Country:US
Mailing Address - Phone:440-812-0974
Mailing Address - Fax:
Practice Address - Street 1:1480 W 8TH ST UPPR
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3322
Practice Address - Country:US
Practice Address - Phone:440-812-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty