MEDICARE: MRS. CHATERRIA D HINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11046213	FL

General Provider Information

NPI Number	:	1730037961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHATERRIA D HINES

Provider Business Mailing Address
First Line	:	421 W BEACON RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-7202
Country	:	US
Telephone Number	:	863-604-6404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 HARDEN BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-5918
Country	:	US
Telephone Number	:	863-284-0534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	06/02/2026

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