Basic Information
| Provider Information | |||||||||
| NPI: | 1275046781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEAN | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 N E ST STE 331 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504307081 | ||||||||
| FaxNumber: | 8504441755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 N E ST STE 331 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504307081 | ||||||||
| FaxNumber: | 8504441755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2017 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9470853 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | ARNP9470853 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 023247700 | 05 | FL | MEDICAID | ARNP-9470853 | 01 | FL | FLORIDA LICENSE | OTHER |