Healthcare Provider Details

I. General information

NPI: 1720920085
Provider Name (Legal Business Name): HEATHER NICOLE TALIB BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12754 78TH PL N
WEST PALM BEACH FL
33412-2245
US

IV. Provider business mailing address

12754 78TH PL N
WEST PALM BEACH FL
33412-2245
US

V. Phone/Fax

Practice location:
  • Phone: 561-260-6180
  • Fax:
Mailing address:
  • Phone: 561-260-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: