Provider Demographics
NPI:1346465424
Name:HEFFRON, JANIS FAITH (EDD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:FAITH
Last Name:HEFFRON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CHOCKASACKA NENE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5810
Mailing Address - Country:US
Mailing Address - Phone:850-544-4505
Mailing Address - Fax:
Practice Address - Street 1:1317 WINEWOOD BLVD STE 6 ROOM 213
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32399-6570
Practice Address - Country:US
Practice Address - Phone:850-487-2902
Practice Address - Fax:850-921-5830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002748103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)