Healthcare Provider Details

I. General information

NPI: 1144252883
Provider Name (Legal Business Name): STEPHEN DARRELL HEGLUND ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13695 US HIGHWAY 1
SEBASTIAN FL
32958-3230
US

IV. Provider business mailing address

1325 19TH AVE SW
VERO BEACH FL
32962-6168
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-2045
  • Fax:
Mailing address:
  • Phone: 772-778-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2826702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: