Provider Demographics
NPI:1386687077
Name:ANDERSON, HEIDI KRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:KRISTINA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:5310 CLARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3230
Practice Address - Country:US
Practice Address - Phone:941-925-3627
Practice Address - Fax:866-405-4932
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-10-31
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Provider Licenses
StateLicense IDTaxonomies
FLME102351207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001635400Medicaid
FLBD904ZMedicare PIN
FLB11627Medicare PIN