Provider Demographics
NPI:1871734459
Name:HEINTZ, LYNDA MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:MICHELLE
Last Name:HEINTZ
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 JAKE ALEXANDER BLVD W
Practice Address - Street 2:STE 105
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1364
Practice Address - Country:US
Practice Address - Phone:704-403-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005626363L00000X, 363LF0000X
NC251966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871734459Medicaid
NC7006163Medicaid
SCNP2083Medicaid
NCNC7966AMedicare PIN
NCNC7966CMedicare PIN
NCNC7966EMedicare PIN
NCNC7966JMedicare PIN
NCNC7966PMedicare PIN
NCNC7966BMedicare PIN
NCNC7966HMedicare PIN
NCNC7966IMedicare PIN
NCNC7966KMedicare PIN
NCNC7966OMedicare PIN
NCNC7966DMedicare PIN
NCNC7966LMedicare PIN
NCNC7966MMedicare PIN
NC7006163Medicaid
SCNP2083Medicaid
NCNC7966FMedicare PIN