Provider Demographics
NPI:1043258635
Name:ANDERSON HEIM, MELINDA L (ARNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:ANDERSON HEIM
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 1:2120 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6028
Mailing Address - Country:US
Mailing Address - Phone:850-494-4885
Mailing Address - Fax:850-494-4910
Practice Address - Street 1:2120 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6028
Practice Address - Country:US
Practice Address - Phone:850-494-4885
Practice Address - Fax:850-494-4910
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1696532363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9259OtherBSFL
FL302977800Medicaid
S53476Medicare UPIN
FLY9259OtherBSFL