Provider Demographics
NPI:1417196379
Name:VINCENT, LINDA M (MS, CCRN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MS, CCRN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 S KINO RD
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-8870
Mailing Address - Country:US
Mailing Address - Phone:520-378-1266
Mailing Address - Fax:
Practice Address - Street 1:6130 S KINO RD
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8870
Practice Address - Country:US
Practice Address - Phone:520-378-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3173363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care