Healthcare Provider Details

I. General information

NPI: 1427543628
Provider Name (Legal Business Name): TINA HEINEMANN MSN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 LANGHORNE RD STE 303
LYNCHBURG VA
24501-1423
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3600
  • Fax:
Mailing address:
  • Phone: 661-635-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024182405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: