Provider Demographics
NPI:1952745754
Name:HARVEY-BLOUNT, TYNSIA RENEE NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:TYNSIA
Middle Name:RENEE NICHOLE
Last Name:HARVEY-BLOUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TYNSIA
Other - Middle Name:RENEE NICHOLE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:561-863-5757
Mailing Address - Fax:561-967-5761
Practice Address - Street 1:4075 S STATE ROAD 7 STE H1
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-8152
Practice Address - Country:US
Practice Address - Phone:561-967-5761
Practice Address - Fax:561-967-5762
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127966208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017638700Medicaid