MEDICARE: HEATHER MOONEYHAN MSN, APN, CNM

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	363LW0102X	Women's Health Nurse Practitioner	APRN11022977	FL

General Provider Information

NPI Number	:	1811426422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MOONEYHAN MSN, APN, CNM

Provider Business Mailing Address
First Line	:	4149 LONICERA LOOP
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-4537
Country	:	US
Telephone Number	:	772-359-8077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4256
Country	:	US
Telephone Number	:	904-296-3200
Fax Number	:

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	12/08/2025

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