JACQUELINE MINTZ (NPI# 1124258967) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124258967 |
| Entity Type | Individual |
| Full Name | JACQUELINE MINTZ |
| Credential | ARNP-FNP |
| Practice Address |
524 Nelson Ave Shaw Afb SC 29152 |
| Mailing Address |
224 Ashley Place Road Columbia SC 29229 |
| Practice Telephone | 7064956612 |
| Mailing Telephone | 7064956612 |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2011-12-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
14-60208-122 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN213453 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
524 NELSON AVE |
| City | SHAW AFB |
| State | SC |
| Zip Code | 29152 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487201695 | Ethan Lee Brockett | Dentist | Shaw Afb Dental Clinic, Shaw Afb, AE 29152 | 2019-08-22 |
| 1275066821 | Travis B Grindstaff | General Acute Care Hospital | 411 Polifka Dr, Shaw Afb, SC 29152 | 2017-04-10 |
| 1851791578 | Terrance Walker | Psychologist | 431 Meadow St, Sumter, SC 29152 | 2014-08-29 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1285899146 | Elizabeth Ann Vandevelde | Nurse Practitioner | 129 North Washington, Tuomey Healthcare System, Sumter, SC 29152 | 2008-07-21 |
| 1134211089 | Kibrom T Mehari | Dentist | 449 Shaw Dr, Shaw A F B, SC 29152 | 2006-09-29 |
| 1134155773 | Theresa Jean Ulichney | Registered Nurse | 420 Polifka Dr, Shaw Afb, SC 29152 | 2006-06-24 |
| 1366415184 | Kimberly Marie Shanks | Nurse Practitioner | 431 Meadowlark Rd, Shaw Afb, SC 29152 | 2006-02-10 |
| 1194710780 | Anthony Shawn Bankes | Family Medicine | 411 Medowlark, Shaw Afb, SC 29152 | 2005-09-20 |
| 1861957516 | Charles Bradford Davis | Physician Assistant | 411 Polifka Dr, Shaw Afb, SC 29152 | 2019-02-07 |
| Find all providers in zip 29152 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124250667 | Lauren Carol Allain | Nurse Practitioner | 431 Meadowlark St., 20th Mdg/sghc, Shaw Afb, SC 29152-5019 | 2009-08-18 |
| 1366415184 | Kimberly Marie Shanks | Nurse Practitioner | 431 Meadowlark Rd, Shaw Afb, SC 29152 | 2006-02-10 |
| 1396232518 | Denise D Garvin | Nurse Practitioner | 420 Polifka Dr Bldg 1042, Shaw Afb, SC 29152-5100 | 2018-04-13 |
| 1881786879 | Daniel Anthony Blaz | Nurse Practitioner | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417557737 | Diondra Johnson | Nurse Practitioner | 2327 Watchtower Ln, Charleston, SC 29414-7803 | 2020-10-27 |
| 1740888262 | Gerri Kukucka | Nurse Practitioner | 18 Ash Ct, Irmo, SC 29063-9584 | 2020-10-16 |
| 1407454853 | William Andrew Haislip | Nurse Practitioner | 109 Anita St, Greer, SC 29651-3814 | 2020-10-16 |
| 1912505652 | Mattison Williams Craig | Nurse Practitioner | 108 Woodstock Ln, Greer, SC 29650-3918 | 2020-10-14 |
| 1669079901 | Kelley Brown Davis | Nurse Practitioner | 2689 Us-1, Elgin, SC 29045 | 2020-10-08 |
| 1518564897 | Erica Odom Mccumbers | Nurse Practitioner | 17 Downing Cir, Gilbert, SC 29054-8483 | 2020-10-08 |
| 1285231845 | Shannon Marie Dunlap | Nurse Practitioner | 3792 Home Branch Rd, Manning, SC 29102-4109 | 2020-10-07 |
| 1588261325 | Crystal Leopard | Nurse Practitioner | 328 Deer Creek Rd, Easley, SC 29640-7615 | 2020-10-05 |
| 1497352595 | Margaret Ann Regnery | Nurse Practitioner | 900 Island Park Dr Ste 104, Daniel Island, SC 29492-7560 | 2020-10-02 |
| 1417564709 | John P Rainchuso | Nurse Practitioner | 299 Three Runs Creek Way, Aiken, SC 29803-1680 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.