MEDICARE: ANDREA A HEITMANN MA, CRC, CCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1437810991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA A HEITMANN MA, CRC, CCM

Provider Business Mailing Address
First Line	:	1391 NW 136TH AVE
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2800
Country	:	US
Telephone Number	:	408-375-6104
Fax Number	:

Provider Business Practice Location Address
First Line	:	6015 BLACKBIRD CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-3807
Country	:	US
Telephone Number	:	408-375-6104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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