Healthcare Provider Details

I. General information

NPI: 1972259448
Provider Name (Legal Business Name): GEORGINA HINES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S POWER RD
MESA AZ
85209-6686
US

IV. Provider business mailing address

1243 W SAND DUNE DR
GILBERT AZ
85233-5616
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-0643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number271316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: