Provider Demographics
NPI:1255679825
Name:HEINTZ, RENEE
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2037
Mailing Address - Country:US
Mailing Address - Phone:727-347-4526
Mailing Address - Fax:727-347-4019
Practice Address - Street 1:1075 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2037
Practice Address - Country:US
Practice Address - Phone:727-347-4526
Practice Address - Fax:727-347-4019
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43214183500000X
NC19349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist