Provider Demographics
NPI:1396909420
Name:TINLEY, GORDON F
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:F
Last Name:TINLEY
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 1:10475 CENTURION PKWY N
Mailing Address - Street 2:SUITE 303
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5003
Mailing Address - Country:US
Mailing Address - Phone:904-399-0350
Mailing Address - Fax:904-399-5914
Practice Address - Street 1:10475 CENTURION PKWY N
Practice Address - Street 2:SUITE 303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5003
Practice Address - Country:US
Practice Address - Phone:904-399-0350
Practice Address - Fax:904-399-5914
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY213231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist