Provider Demographics
NPI:1750181889
Name:TINER, CHANCE STEWART (NP)
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:STEWART
Last Name:TINER
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 GA HIGHWAY 32 E
Mailing Address - Street 2:
Mailing Address - City:MERSHON
Mailing Address - State:GA
Mailing Address - Zip Code:31551-2054
Mailing Address - Country:US
Mailing Address - Phone:912-281-9148
Mailing Address - Fax:
Practice Address - Street 1:865 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0210
Practice Address - Country:US
Practice Address - Phone:912-816-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN294402163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency