MEDICARE: INEZ MARIA TINSLEY-DALTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME69919	FL

General Provider Information

NPI Number	:	1740468636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INEZ MARIA TINSLEY-DALTON M.D.

Provider Business Mailing Address
First Line	:	620 CRASSAS DR
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4701
Country	:	US
Telephone Number	:	321-537-9807
Fax Number	:	321-773-3518

Provider Business Practice Location Address
First Line	:	2060 A1A HWY STE 307
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-537-9807
Fax Number	:	321-773-3518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/04/2008

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