Provider Demographics
NPI:1275726143
Name:HARTSOCK, HEATHER ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HARTSOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 HUGHES CT STE 204
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6249
Mailing Address - Country:US
Mailing Address - Phone:281-534-1300
Mailing Address - Fax:281-534-1306
Practice Address - Street 1:3828 HUGHES CT STE 204
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6249
Practice Address - Country:US
Practice Address - Phone:281-534-1300
Practice Address - Fax:281-534-1306
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760010407OtherEIN
TX00R518Medicare PIN
TX760010407OtherEIN