Healthcare Provider Details

I. General information

NPI: 1710403878
Provider Name (Legal Business Name): HEATHER AUFDERHEIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2017
Last Update Date: 08/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 KILLARNEY WAY
TALLAHASSEE FL
32309-3118
US

IV. Provider business mailing address

2401 KILLARNEY WAY
TALLAHASSEE FL
32309-3118
US

V. Phone/Fax

Practice location:
  • Phone: 18507662855
  • Fax:
Mailing address:
  • Phone: 18507662855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number13059
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9457556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: