Healthcare Provider Details

I. General information

NPI: 1336706548
Provider Name (Legal Business Name): HEATHER LEANN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 VISCAYA PKWY STE 2
CAPE CORAL FL
33990-6200
US

IV. Provider business mailing address

17215 CASTLEVIEW DR
N FORT MYERS FL
33917-3825
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-0111
  • Fax: 239-772-0267
Mailing address:
  • Phone: 239-872-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberINPROCESS
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: