Healthcare Provider Details

I. General information

NPI: 1467826081
Provider Name (Legal Business Name): MARLA TINSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 CONTINENTIAL DRIVE
DOTHAN AL
36301-4406
US

IV. Provider business mailing address

1202 CONTINENTIAL DRIVE
DOTHAN AL
36301-4406
US

V. Phone/Fax

Practice location:
  • Phone: 229-308-7625
  • Fax:
Mailing address:
  • Phone: 229-308-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: