Provider Demographics
NPI:1386014710
Name:RATLEFF, HEAVEN
Entity Type:Individual
Prefix:
First Name:HEAVEN
Middle Name:
Last Name:RATLEFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 4TH ST N APT 1605
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2742
Mailing Address - Country:US
Mailing Address - Phone:330-274-7550
Mailing Address - Fax:
Practice Address - Street 1:11601 4TH ST N APT 1605
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2742
Practice Address - Country:US
Practice Address - Phone:330-274-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN159808164W00000X
372600000X, 3747P1801X, 376J00000X
FLPN5235893164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker