Provider Demographics
NPI:1164056313
Name:HEIMKE, TAYLOR RENEE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:HEIMKE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 GARFIELD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8239
Mailing Address - Country:US
Mailing Address - Phone:248-860-7035
Mailing Address - Fax:
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1505
Practice Address - Country:US
Practice Address - Phone:248-723-5880
Practice Address - Fax:248-723-5889
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner