Individual
JACQUELINE MINTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP-FNP
Contact information
Practice address
524 NELSON AVE, SHAW AFB, SC 29152
(706) 495-6612
Mailing address
224 ASHLEY PLACE ROAD, COLUMBIA, SC 29229
(706) 495-6612
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
14-60208-122
KS
363LF0000X
Family Nurse Practitioner
Primary
RN213453
GA
Other
Enumeration date
07/14/2009
Last updated
12/21/2011
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