Provider Demographics
NPI:1265968283
Name:TINSLEY, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W LUCERNE CIR
Mailing Address - Street 2:APT. # 912
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 W LUCERNE CIR
Practice Address - Street 2:APT. # 912
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3728
Practice Address - Country:US
Practice Address - Phone:407-450-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide