Provider Demographics
NPI:1972311587
Name:HINES, MIRANDA (FNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 WOODLAND BROOK LN E
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3644
Mailing Address - Country:US
Mailing Address - Phone:901-585-5574
Mailing Address - Fax:
Practice Address - Street 1:751 WOODLAND BROOK LN E
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3644
Practice Address - Country:US
Practice Address - Phone:901-585-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN234693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse