Provider Demographics
NPI:1831385376
Name:TINNEY, MARCHEL D (APN)
Entity type:Individual
Prefix:MS
First Name:MARCHEL
Middle Name:D
Last Name:TINNEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARCHEL
Other - Middle Name:D
Other - Last Name:RAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4841 HIXSON PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4431
Mailing Address - Country:US
Mailing Address - Phone:423-305-7980
Mailing Address - Fax:423-305-7981
Practice Address - Street 1:4841 HIXSON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4431
Practice Address - Country:US
Practice Address - Phone:423-305-7980
Practice Address - Fax:423-305-7981
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
11789785OtherCAQH #
TN103I508305Medicare PIN
TN1016710001Medicare NSC