Healthcare Provider Details

I. General information

NPI: 1124577887
Provider Name (Legal Business Name): HEIDI H COOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

1622 TALL PINES TRL
LAKELAND FL
33810-0186
US

V. Phone/Fax

Practice location:
  • Phone: 813-755-3500
  • Fax: 813-755-3300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9165104
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9165104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: