Provider Demographics
NPI:1881817492
Name:HINES, SHARON L (APRN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:HINES
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 1:536 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4712
Mailing Address - Country:US
Mailing Address - Phone:860-358-2220
Mailing Address - Fax:860-358-2222
Practice Address - Street 1:536 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4712
Practice Address - Country:US
Practice Address - Phone:860-358-2220
Practice Address - Fax:860-358-2222
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP69729Medicare UPIN