MEDICARE: MRS. TINA JEAN HAYES CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	118410	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427080357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA JEAN HAYES CNM

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-2021
Fax Number	:	704-316-2025

Provider Business Practice Location Address
First Line	:	5933 BLAKENEY PARK DR
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-5713
Country	:	US
Telephone Number	:	704-316-2021
Fax Number	:	704-316-2025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/27/2020

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