Healthcare Provider Details

I. General information

NPI: 1962893784
Provider Name (Legal Business Name): HEATHER VAN GELDREN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7615 WOODLAND CREEK LN
LAKE WORTH FL
33467-6522
US

IV. Provider business mailing address

7615 WOODLAND CREEK LN
LAKE WORTH FL
33467-6522
US

V. Phone/Fax

Practice location:
  • Phone: 561-574-5629
  • Fax:
Mailing address:
  • Phone: 561-574-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9270620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: