Provider Demographics
NPI:1003379009
Name:HEAVEY, NICOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HEAVEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6388 SILVER STAR RD STE 2H
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3235
Mailing Address - Country:US
Mailing Address - Phone:135-220-5914
Mailing Address - Fax:
Practice Address - Street 1:579 EDGERLY PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4712
Practice Address - Country:US
Practice Address - Phone:321-698-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily