Provider Demographics
NPI:1275887531
Name:HEATH, KANDI MARI (RN-FNP)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:MARI
Last Name:HEATH
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BLUEJACK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-9029
Mailing Address - Country:US
Mailing Address - Phone:304-534-0684
Mailing Address - Fax:
Practice Address - Street 1:105 JULINGTON PLAZA DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-6218
Practice Address - Country:US
Practice Address - Phone:904-582-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN75923-FNP-BC363LF0000X
MDAC005770363LF0000X
FL1108172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026167Medicaid
WV1275887531Medicaid
WV3810024049OtherGROUP MEDICAID
WV3810026167Medicaid
WV3810024049OtherGROUP MEDICAID