Provider Demographics
NPI:1922073618
Name:HINZMAN, JACKIE M (PA- C)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:M
Last Name:HINZMAN
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W SPRINGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-8742
Mailing Address - Country:US
Mailing Address - Phone:402-476-6738
Mailing Address - Fax:
Practice Address - Street 1:2662 CORNHUSKER HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1464
Practice Address - Country:US
Practice Address - Phone:402-423-0396
Practice Address - Fax:402-423-0397
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1214363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91177983268510A018OtherTRI CARE
NE247113OtherMIDLANDS CHOICE
NE91177983268510A018OtherTRI CARE
Q53255Medicare UPIN