Healthcare Provider Details

I. General information

NPI: 1578943072
Provider Name (Legal Business Name): TYSHONDA DOWNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 ANTOINETTE ST
DELTONA FL
32725-2621
US

IV. Provider business mailing address

662 ANTOINETTE ST
DELTONA FL
32725-2621
US

V. Phone/Fax

Practice location:
  • Phone: 386-218-4939
  • Fax: 386-218-4938
Mailing address:
  • Phone: 386-218-4939
  • Fax: 386-218-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: