MEDICARE: JENNIFER SUE HEETER FNP

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	207Q00000X	Family Medicine Physician	RN175650	AZ
2	363L00000X	Nurse Practitioner	235841	AZ

General Provider Information

NPI Number	:	1487114054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUE HEETER FNP

Provider Business Mailing Address
First Line	:	23867 W HIDALGO AVE
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-7008
Country	:	US
Telephone Number	:	330-631-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 E BASELINE RD STE 101
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1546
Country	:	US
Telephone Number	:	888-381-4858
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	09/27/2024

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