Healthcare Provider Details

I. General information

NPI: 1659877553
Provider Name (Legal Business Name): HEIDI ANN CASILLAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI ANN MILLIGAN

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 04/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 7TH AVE N
ST PETERSBURG FL
33705-1300
US

IV. Provider business mailing address

1885 43RD ST N
ST PETERSBURG FL
33713-4604
US

V. Phone/Fax

Practice location:
  • Phone: 727-825-1100
  • Fax:
Mailing address:
  • Phone: 708-289-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9224711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: