Healthcare Provider Details

I. General information

NPI: 1881032167
Provider Name (Legal Business Name): HEATHER HOUSE VILLARREAL CRNA, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. HEATHER RENE HOUSE

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9099 GRAPHITE CIR
NAPLES FL
34120-5227
US

IV. Provider business mailing address

9099 GRAPHITE CIR
NAPLES FL
34120-5227
US

V. Phone/Fax

Practice location:
  • Phone: 864-320-5256
  • Fax:
Mailing address:
  • Phone: 864-320-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number22409
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9300686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: