=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588049225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRUDY HEPP ENGLISH ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2015
-----------------------------------------------------
Last Update Date | 07/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 W TOWN PL
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32092-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-094-0157
-----------------------------------------------------
Fax | 904-940-1916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 W TOWN PL
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32092-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-094-0157
-----------------------------------------------------
Fax | 904-940-1916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 9301696
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------