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General NPI Number Information
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NPI Number | 1043954613
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Entity Type | Individual
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Provider Name | MS. TANISHA HINES
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Gender | Female
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 7001 NW 4TH BLVD
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City | GAINESVILLE
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State | FL
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Zip | 32607-1679
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Country | US
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Telephone | 888-619-6499
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 NW 13TH ST # 226
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City | GAINESVILLE
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State | FL
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Zip | 32609-2835
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Country | US
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Telephone | 352-415-5128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | H5208165280
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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