Provider Demographics
NPI:1043103898
Name:HINES, TANISHA
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:HINES
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 1:4564 SYLVAN OAK DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2122
Mailing Address - Country:US
Mailing Address - Phone:937-701-9233
Mailing Address - Fax:
Practice Address - Street 1:4564 SYLVAN OAK DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2122
Practice Address - Country:US
Practice Address - Phone:937-701-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver