=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053744391
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER BROOM HOLDINESS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2013
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 903 DESOTO BLVD
-----------------------------------------------------
City | HOT SPRINGS VILLAGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71909-6100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-922-6266
-----------------------------------------------------
Fax | 501-922-8122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8333 N DAVIS HWY
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32514-6050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-474-8385
-----------------------------------------------------
Fax | 850-969-2904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | A004582
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | A004582
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | A004582
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------