Provider Demographics
NPI:1992571277
Name:HAYNES, TYSHIRA M (CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:TYSHIRA
Middle Name:M
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 LOVEBIRD CT APT H
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2471
Mailing Address - Country:US
Mailing Address - Phone:269-443-4437
Mailing Address - Fax:
Practice Address - Street 1:2141 LOVEBIRD CT APT H
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2471
Practice Address - Country:US
Practice Address - Phone:269-443-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide