Healthcare Provider Details

I. General information

NPI: 1144987165
Provider Name (Legal Business Name): TINA SINES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 LABELLE ST
JACKSONVILLE FL
32205-6977
US

IV. Provider business mailing address

1214 LABELLE ST APT 159
JACKSONVILLE FL
32205-6975
US

V. Phone/Fax

Practice location:
  • Phone: 904-878-2204
  • Fax: 904-467-3653
Mailing address:
  • Phone: 904-598-4551
  • Fax: 904-467-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA SINES
Title or Position: OWNER/OPERATOR
Credential:
Phone: 904-598-4551