Provider Demographics
NPI:1134632581
Name:HENTZ, LINDA KAYE MYERS (APRN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAYE MYERS
Last Name:HENTZ
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 1:8 RICHLAND MEDICAL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8008
Mailing Address - Country:US
Mailing Address - Phone:803-256-6511
Mailing Address - Fax:803-744-4731
Practice Address - Street 1:8 RICHLAND MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8008
Practice Address - Country:US
Practice Address - Phone:803-256-6511
Practice Address - Fax:803-744-4731
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21446363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care