Provider Demographics
NPI:1346438595
Name:MAROUDAS, HEATHER M (CNM, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:MAROUDAS
Suffix:
Gender:F
Credentials:CNM, FNP-BC
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Mailing Address - Street 1:15523 KNOLLMEADOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2141
Mailing Address - Country:US
Mailing Address - Phone:210-381-5805
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:112 MAVERICK CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-1381
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:888-732-8119
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP119917363LF0000X, 363L00000X, 363LW0102X, 363LF0000X
GARN162935367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291811202Medicaid
TXTXB145397Medicare PIN