Healthcare Provider Details

I. General information

NPI: 1275031973
Provider Name (Legal Business Name): HEATHER LYNETTE FLORES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MERIDIAN ST N
HUNTSVILLE AL
35801-4720
US

IV. Provider business mailing address

688 WADE RD SE
OWENS CROSS ROADS AL
35763-9120
US

V. Phone/Fax

Practice location:
  • Phone: 256-372-5601
  • Fax: 256-372-5599
Mailing address:
  • Phone: 719-235-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-148004
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: