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General NPI Number Information
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NPI Number | 1730646662
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Entity Type | Individual
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Provider Name | VIRANDA D WHITE-TINSLEY
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Gender | Female
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 2044 DEAN A AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32208-3711
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Country | US
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Telephone | 904-374-0217
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 441435
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City | JACKSONVILLE
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State | FL
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Zip | 32222-0014
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Country | US
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Telephone | 904-584-5724
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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