Provider Demographics
NPI:1932575305
Name:FITZGERALD HINTZ, PEG (CNP)
Entity Type:Individual
Prefix:
First Name:PEG
Middle Name:
Last Name:FITZGERALD HINTZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 ZION ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4039
Mailing Address - Country:US
Mailing Address - Phone:952-270-2234
Mailing Address - Fax:651-431-7718
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:651-431-5162
Practice Address - Fax:651-431-7718
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1793293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily