=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164411708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER JEAN STALKER M.SC., C.G.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2005
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | DIVISION OF PEDIATRIC GENETICS, UNIVERSITY OF FLORIDA BOX 100296
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32610-0296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-392-8032
-----------------------------------------------------
Fax | 352-392-3051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BOX 100296 1700 SW 16TH AVE
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32610-7703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-294-5042
-----------------------------------------------------
Fax | 352-294-8058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 41
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 298
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------