Healthcare Provider Details

I. General information

NPI: 1740898667
Provider Name (Legal Business Name): HEATHER ALLISON MCDERMOTT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER JAQUEZ

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 SPIRIT CT
TRINITY FL
34655-5183
US

IV. Provider business mailing address

8045 SPIRIT CT
TRINITY FL
34655-5183
US

V. Phone/Fax

Practice location:
  • Phone: 352-263-3770
  • Fax:
Mailing address:
  • Phone: 352-263-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: