Healthcare Provider Details

I. General information

NPI: 1619654142
Provider Name (Legal Business Name): MARIA INES PEREYRA HEYWARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DOUG WHITE DR STE 250
MYRTLE BEACH SC
29572-4181
US

IV. Provider business mailing address

687 UNIOLA DR
MYRTLE BEACH SC
29579-3629
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-1000
  • Fax:
Mailing address:
  • Phone: 843-368-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27542
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: