Healthcare Provider Details

I. General information

NPI: 1497797674
Provider Name (Legal Business Name): JESSICA MICHELLE HECKEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JESSICA MICHELLE HECKEL

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD BOX 100371
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

PO BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-1300
  • Fax: 352-334-1521
Mailing address:
  • Phone: 352-265-0301
  • Fax: 352-265-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9193480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: