=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710744776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURENCE HEATWOLE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2024
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 S CONGRESS AVE STE 204
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-6637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-967-4118
-----------------------------------------------------
Fax | 561-967-3463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8078 SAW PALMETTO LN
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-398-8830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11031318
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN11031318
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------