Healthcare Provider Details

I. General information

NPI: 1366861981
Provider Name (Legal Business Name): HEATHER D NIELSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DENTON DO

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14830 INGLE LN
JACKSONVILLE FL
32223-8658
US

IV. Provider business mailing address

14830 INGLE LN
JACKSONVILLE FL
32223-8658
US

V. Phone/Fax

Practice location:
  • Phone: 205-223-6261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13363
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: