Healthcare Provider Details

I. General information

NPI: 1063910057
Provider Name (Legal Business Name): HEATHER BROOKE FLYNN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

IV. Provider business mailing address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5310
  • Fax:
Mailing address:
  • Phone: 850-878-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN209302
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11028001
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: