Provider Demographics
NPI:1023218740
Name:CHRISTIE, HEATHER LAROCK (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAROCK
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 9TH AVE N STE 240
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7148
Mailing Address - Country:US
Mailing Address - Phone:727-220-9080
Mailing Address - Fax:
Practice Address - Street 1:2191 9TH AVE N STE 240
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7148
Practice Address - Country:US
Practice Address - Phone:727-220-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128143207Q00000X
FLME139863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH75312Medicare UPIN
NC2022638AMedicare PIN
NC2022638Medicare PIN