Basic Information
| Provider Information | |||||||||
| NPI: | 1386026607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEATON | ||||||||
| FirstName: | TANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 157 PROFESSIONAL PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281175606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046623967 | ||||||||
| FaxNumber: | 7046623975 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 PROFESSIONAL PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281175606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046623967 | ||||||||
| FaxNumber: | 7046623975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2015 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 158400 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.