Provider Demographics
NPI:1942704218
Name:TINNESZ-BASKERVILLE, SARA
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:TINNESZ-BASKERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:TINNESZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2220 COUNTY ROAD 210 WEST
Mailing Address - Street 2:SUITE 108, PMB 169
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6601
Mailing Address - Country:US
Mailing Address - Phone:904-563-5875
Mailing Address - Fax:904-696-9868
Practice Address - Street 1:6339 ARGYLE FOREST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6601
Practice Address - Country:US
Practice Address - Phone:904-563-5875
Practice Address - Fax:904-696-9868
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst