=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801229554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER GOLDNER DNP, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2013
-----------------------------------------------------
Last Update Date | 07/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 N VERMONT AVE
-----------------------------------------------------
City | ATLANTIC CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08401-5561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-344-8900
-----------------------------------------------------
Fax | 609-344-8659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 S GATEWAY
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08753-6616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-924-0609
-----------------------------------------------------
Fax | 732-561-1145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00449600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------