Healthcare Provider Details

I. General information

NPI: 1356377303
Provider Name (Legal Business Name): ADAM BERNARD HEINRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 TAMIAMI TRL E STE 205
NAPLES FL
34113-8421
US

IV. Provider business mailing address

12250 TAMIAMI TRL E STE 205
NAPLES FL
34113-8421
US

V. Phone/Fax

Practice location:
  • Phone: 239-799-7057
  • Fax:
Mailing address:
  • Phone: 239-799-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9388124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: