Provider Demographics
NPI:1376529180
Name:HENTZEN, FLORENCE BETH (APRN)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:BETH
Last Name:HENTZEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 16TH STREET
Mailing Address - Street 2:MEDICAL TOWER B, #305
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502
Mailing Address - Country:US
Mailing Address - Phone:402-488-3002
Mailing Address - Fax:402-483-8787
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:#400
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-488-3002
Practice Address - Fax:402-483-8787
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28524163W00000X
NE110090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061995513Medicaid
NER81588Medicare UPIN