Healthcare Provider Details

I. General information

NPI: 1518254143
Provider Name (Legal Business Name): HEATHER KAY MOOREHEAD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER KAY POUCHER ACNP-BC

II. Dates (important events)

Enumeration Date: 07/04/2011
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 COLONIAL CENTER DR STE 302
FORT MYERS FL
33905-7810
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9700
  • Fax: 239-343-9699
Mailing address:
  • Phone: 239-343-9700
  • Fax: 239-343-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704253434
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704253434
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9426987
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704253434
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9426987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: