Provider Demographics
NPI:1992268908
Name:TYNDALE, MARJEAN (FNP)
Entity type:Individual
Prefix:
First Name:MARJEAN
Middle Name:
Last Name:TYNDALE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LAKE PORT DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5452
Mailing Address - Country:US
Mailing Address - Phone:770-736-1918
Mailing Address - Fax:
Practice Address - Street 1:2800 LAKE PORT DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-5452
Practice Address - Country:US
Practice Address - Phone:770-736-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA166649363LF0000X
GARN166649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily