Provider Demographics
NPI:1326556036
Name:UPCHURCH, HEATHER DAWN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8419
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-219-2347
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8419
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-219-2347
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9323675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily