Healthcare Provider Details

I. General information

NPI: 1043755069
Provider Name (Legal Business Name): LINDA LOUISE HEILMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax: 904-259-9147
Mailing address:
  • Phone: 904-259-3151
  • Fax: 904-259-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9303138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: