Healthcare Provider Details

I. General information

NPI: 1952792459
Provider Name (Legal Business Name): CALLIE HEILIG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE LECROY APRN

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

IV. Provider business mailing address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

V. Phone/Fax

Practice location:
  • Phone: 251-605-2135
  • Fax:
Mailing address:
  • Phone: 850-763-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number77226
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77226
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11018308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: