Provider Demographics
NPI:1871606970
Name:STINNETT, TIANNA N (PA)
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:N
Last Name:STINNETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TIANA
Other - Middle Name:N
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1180 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2347
Mailing Address - Country:US
Mailing Address - Phone:810-577-7189
Mailing Address - Fax:
Practice Address - Street 1:1 HURLEY PLZ # 7B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-262-9355
Practice Address - Fax:810-262-6341
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M94800P44Medicare ID - Type Unspecified