Healthcare Provider Details

I. General information

NPI: 1245988963
Provider Name (Legal Business Name): ELIZABETH ANNE HEGLAND FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2694 NC 24-87
CAMERON NC
28326-6957
US

IV. Provider business mailing address

346 N PRINCE HENRY WAY
CAMERON NC
28326-5055
US

V. Phone/Fax

Practice location:
  • Phone: 919-373-3636
  • Fax:
Mailing address:
  • Phone: 510-673-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number308976
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: