Healthcare Provider Details

I. General information

NPI: 1649381880
Provider Name (Legal Business Name): HEATHER WILFONG SVENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANNE TAYLOR M.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 PLANTATION OAKS BLVD
ORANGE PARK FL
32065-3641
US

IV. Provider business mailing address

13626 SHIPWATCH DR
JACKSONVILLE FL
32225-5402
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0820
  • Fax:
Mailing address:
  • Phone: 912-399-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number050841
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME119017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: