Provider Demographics
NPI:1427080357
Name:HAYES, TINA JEAN (CNM)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:JEAN
Last Name:HAYES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2021
Mailing Address - Fax:704-316-2025
Practice Address - Street 1:5933 BLAKENEY PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5713
Practice Address - Country:US
Practice Address - Phone:704-316-2021
Practice Address - Fax:704-316-2025
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118410367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002160Medicaid
SCMW0187Medicaid
NC1427080357Medicaid
NC7002160Medicaid
P46704Medicare UPIN
NC1427080357Medicaid
SCMW0187Medicaid