Healthcare Provider Details

I. General information

NPI: 1396112447
Provider Name (Legal Business Name): ALEXIS HEFFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 13TH ST 206
BOCA RATON FL
33486
US

IV. Provider business mailing address

900 NW 13TH ST 206
BOCA RATON FL
33486-2335
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-3267
  • Fax: 561-391-4420
Mailing address:
  • Phone: 561-338-3267
  • Fax: 561-391-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: