Healthcare Provider Details

I. General information

NPI: 1962366047
Provider Name (Legal Business Name): JOVANY TINNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 SCAGGSVILLE RD
LAUREL MD
20723
US

IV. Provider business mailing address

10506 SCAGGSVILLE RD
LAUREL MD
20723
US

V. Phone/Fax

Practice location:
  • Phone: 301-825-3744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: