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General NPI Number Information
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NPI Number | 1447296108
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Entity Type | Individual
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Provider Name | HEATHER LEA MIXSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 400 PINELLAS ST STE 300
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City | CLEARWATER
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State | FL
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Zip | 33756-3314
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Country | US
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Telephone | 727-447-8100
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Fax | 727-461-2603
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Provider Business Mailing Address
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Address Line | PO BOX 102222 ATTN: CREDENTIAL DEPARTMENT
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City | ATLANTA
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State | GA
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Zip | 30368-2222
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Country | US
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Telephone | 239-274-8200
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Fax | 239-278-3350
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP3246542
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License Number State | FL
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