Provider Demographics
NPI:1417736901
Name:HINKELMAN, EDWARD THOMAS
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:THOMAS
Last Name:HINKELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 DEER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-5042
Mailing Address - Country:US
Mailing Address - Phone:386-416-9648
Mailing Address - Fax:
Practice Address - Street 1:802 DEER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-5042
Practice Address - Country:US
Practice Address - Phone:386-416-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH524238954711343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)