Healthcare Provider Details

I. General information

NPI: 1073071866
Provider Name (Legal Business Name): HEATHER DICKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13137 SORRENTO RD
PENSACOLA FL
32507-8777
US

IV. Provider business mailing address

11706 ARUBA DR
PENSACOLA FL
32506-1214
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-0020
  • Fax: 850-492-6340
Mailing address:
  • Phone: 850-637-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10180506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: