Healthcare Provider Details

I. General information

NPI: 1447296108
Provider Name (Legal Business Name): HEATHER LEA MIXSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINELLAS ST STE 300
CLEARWATER FL
33756-3314
US

IV. Provider business mailing address

PO BOX 102222 ATTN: CREDENTIAL DEPARTMENT
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-8100
  • Fax: 727-461-2603
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3246542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: