Provider Demographics
NPI:1275046781
Name:DEAN, HEATHER (ARNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N E ST STE 331
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6335
Mailing Address - Country:US
Mailing Address - Phone:850-430-7081
Mailing Address - Fax:850-444-1755
Practice Address - Street 1:1717 N E ST STE 331
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-430-7081
Practice Address - Fax:850-444-1755
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9470853363LF0000X
FLARNP9470853363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023247700Medicaid
FLARNP-9470853OtherFLORIDA LICENSE