Healthcare Provider Details

I. General information

NPI: 1043867229
Provider Name (Legal Business Name): MELISSA HINES-ANTICO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA HINES

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ASHVILLE AVE STE 310
CARY NC
27518-8682
US

IV. Provider business mailing address

PO BOX 117287
ATLANTA GA
30368-7287
US

V. Phone/Fax

Practice location:
  • Phone: 919-233-8585
  • Fax: 919-233-8566
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5014432
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: