Healthcare Provider Details

I. General information

NPI: 1861823965
Provider Name (Legal Business Name): WINIFRED HEFLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2013
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14660 SE 77TH CT
SUMMERFIELD FL
34491-4206
US

IV. Provider business mailing address

7725 SE 147TH PL
SUMMERFIELD FL
34491-4237
US

V. Phone/Fax

Practice location:
  • Phone: 352-245-5932
  • Fax: 352-245-6275
Mailing address:
  • Phone: 352-245-5932
  • Fax: 352-245-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1431942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number00042314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: