=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730037961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. CHATERRIA D HINES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2026
-----------------------------------------------------
Last Update Date | 03/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 HARDEN BLVD
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-5918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-284-0534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 W BEACON RD
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-7202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-604-6404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 11046213
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------