=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154117109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ALBERT HINCHLIFFE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 06/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 MICCOSUKEE RD
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-5054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-431-1155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1607 SAINT JAMES CT STE 2
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-4658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-878-8714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Registered Nurse
-----------------------------------------------------
License Number | RN9479948
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Nurse Practitioner
-----------------------------------------------------
License Number | APRN11040000
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------