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General NPI Number Information
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NPI Number | 1811426422
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Entity Type | Individual
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Provider Name | HEATHER MOONEYHAN MSN, APN, CNM
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Gender | Female
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 3627 UNIVERSITY BLVD S STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4256
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Country | US
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Telephone | 904-296-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 4149 LONICERA LOOP
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City | SAINT JOHNS
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State | FL
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Zip | 32259-4537
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Country | US
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Telephone | 772-359-8077
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Fax |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN11022977
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License Number State | FL
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