Provider Demographics
NPI:1043340342
Name:DR YOVANNI TINEO P A
Entity type:Organization
Organization Name:DR YOVANNI TINEO P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:TINEO
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:239-592-5655
Mailing Address - Street 1:90 CYPRESS WAY E STE 10
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:239-592-5655
Mailing Address - Fax:239-592-1370
Practice Address - Street 1:90 CYPRESS WAY E STE 10
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-592-5655
Practice Address - Fax:239-592-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79339OtherBCBS
FL79339AMedicare ID - Type Unspecified
FL79339OtherBCBS