Provider Demographics
NPI:1003112525
Name:HEISE, AMINA MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:MICHELLE
Last Name:HEISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMINA
Other - Middle Name:MICHELLE
Other - Last Name:BARBIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4800
Mailing Address - Country:US
Mailing Address - Phone:858-309-6303
Mailing Address - Fax:858-309-6301
Practice Address - Street 1:8110 BIRMINGHAM WAY BLDG 28
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2758
Practice Address - Country:US
Practice Address - Phone:858-966-4003
Practice Address - Fax:858-560-6798
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner