Provider Demographics
NPI:1326458159
Name:WELLS, HEATHER ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELAINE
Last Name:WELLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 W GULF BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32328-2512
Mailing Address - Country:US
Mailing Address - Phone:850-419-7319
Mailing Address - Fax:
Practice Address - Street 1:807 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-3237
Practice Address - Country:US
Practice Address - Phone:850-568-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine