Healthcare Provider Details

I. General information

NPI: 1952633059
Provider Name (Legal Business Name): AMY L HEYDEN RN, MS, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 METRO PKWY STE 1
FORT MYERS FL
33966-1206
US

IV. Provider business mailing address

11215 METRO PKWY STE 1
FORT MYERS FL
33966-1206
US

V. Phone/Fax

Practice location:
  • Phone: 239-208-2212
  • Fax: 716-712-0933
Mailing address:
  • Phone: 239-208-2212
  • Fax: 716-712-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: