Healthcare Provider Details

I. General information

NPI: 1326494527
Provider Name (Legal Business Name): HEATHER BRUMBLEY CONLON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

931 A1A BEACH BLVD UNIT 205
SAINT AUGUSTINE FL
32080-5744
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-9925
  • Fax:
Mailing address:
  • Phone: 229-886-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9320377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: