Provider Demographics
NPI:1801438254
Name:MINTZ, DENA MICHELLE (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:DENA
Middle Name:MICHELLE
Last Name:MINTZ
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EDGEMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-725-4976
Mailing Address - Fax:
Practice Address - Street 1:6420 B GEORGE WASHINGTON MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23269
Practice Address - Country:US
Practice Address - Phone:757-969-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine