Provider Demographics
NPI:1770289449
Name:CHESS, TYNNATTA (AGENCY/GROUP)
Entity type:Individual
Prefix:
First Name:TYNNATTA
Middle Name:
Last Name:CHESS
Suffix:
Gender:F
Credentials:AGENCY/GROUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SILVER DOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-4412
Mailing Address - Country:US
Mailing Address - Phone:352-281-0072
Mailing Address - Fax:
Practice Address - Street 1:119 SILVER DOLLAR DR
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-4412
Practice Address - Country:US
Practice Address - Phone:352-281-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL164930376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide