MEDICARE: LAURENCE HEATWOLE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN11031318	FL
2	363LA2100X	Acute Care Nurse Practitioner	APRN11031318	FL

General Provider Information

NPI Number	:	1710744776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURENCE HEATWOLE APRN

Provider Business Mailing Address
First Line	:	8078 SAW PALMETTO LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1428
Country	:	US
Telephone Number	:	561-398-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 S CONGRESS AVE STE 204
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6637
Country	:	US
Telephone Number	:	561-967-4118
Fax Number	:	561-967-3463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	01/07/2026

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Directions to “ LAURENCE HEATWOLE APRN” Practice Location

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