Basic Information
| Provider Information | |||||||||
| NPI: | 1760839856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINE | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 SE 28TH LOOP | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344715323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291743 | ||||||||
| FaxNumber: | 3526291748 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 W COLONIAL DR STE 288 | ||||||||
| Address2: | |||||||||
| City: | OCOEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347613432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075213600 | ||||||||
| FaxNumber: | 4075213603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2016 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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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 | 363A00000X | PA9109777 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.