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General NPI Number Information
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NPI Number | 1033136072
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Entity Type | Individual
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Provider Name | HEATHER MICHELLE WADE APRN
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Gender | Female
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 421 KINGSLEY AVE STE 300
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City | ORANGE PARK
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State | FL
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Zip | 32073-4898
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Country | US
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Telephone | 904-621-0643
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Fax | 904-621-0644
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Provider Business Mailing Address
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Address Line | 705 WELLS RD STE 300
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City | ORANGE PARK
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State | FL
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Zip | 32073-2982
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Country | US
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Telephone | 904-282-6331
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Fax | 904-619-1080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9206589
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License Number State | FL
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