Provider Demographics
NPI:1932989746
Name:MINTZ, RENITA ALETHA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:RENITA
Middle Name:ALETHA
Last Name:MINTZ
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:PO BOX 4314
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509
Mailing Address - Country:US
Mailing Address - Phone:803-378-3444
Mailing Address - Fax:
Practice Address - Street 1:2227 BODRICK CIRCLE APT. 205
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3351
Practice Address - Country:US
Practice Address - Phone:803-378-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028234363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health