Provider Demographics
NPI:1922806702
Name:BRUNNER, TINASHIA SHANICE
Entity type:Individual
Prefix:
First Name:TINASHIA
Middle Name:SHANICE
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2268
Mailing Address - Country:US
Mailing Address - Phone:513-687-9195
Mailing Address - Fax:
Practice Address - Street 1:2306 GARRISON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2268
Practice Address - Country:US
Practice Address - Phone:513-687-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 3747P1801X, 253Z00000X
OHOH-14726-104709246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant