Healthcare Provider Details

I. General information

NPI: 1851908701
Provider Name (Legal Business Name): HEIDI RAMAZANZADEH AZARI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MEMORIAL MEDICAL PKWY
PALM COAST FL
32164-5980
US

IV. Provider business mailing address

PO BOX 935921
ATLANTA GA
31193-5921
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-4243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberAPRN11009204
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: