Healthcare Provider Details

I. General information

NPI: 1710571393
Provider Name (Legal Business Name): HEATHER PEDRONCELLI MSN APRN CPNP-PC CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S NEDDERMAN DR
ARLINGTON TX
76019-9800
US

IV. Provider business mailing address

701 S NEDDERMAN DR
ARLINGTON TX
76019-9800
US

V. Phone/Fax

Practice location:
  • Phone: 972-567-4253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1017246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: