Provider Demographics
NPI:1114384823
Name:HELLER, JANICE (LM, AP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:LM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 E SAILBOAT DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1032
Mailing Address - Country:US
Mailing Address - Phone:954-922-2100
Mailing Address - Fax:866-813-9258
Practice Address - Street 1:4006 E SAILBOAT DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1032
Practice Address - Country:US
Practice Address - Phone:954-922-2100
Practice Address - Fax:866-813-9258
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP502171100000X
FLMWOOOO17176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340685700Medicaid