Healthcare Provider Details

I. General information

NPI: 1164209334
Provider Name (Legal Business Name): ANDREA RENEA HEFNER DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E REDSTONE AVE STE 110
CRESTVIEW FL
32539-5355
US

IV. Provider business mailing address

1218 JEFFERYSCOT DR
CRESTVIEW FL
32536-4289
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-5922
  • Fax: 850-398-6133
Mailing address:
  • Phone: 850-305-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: