Provider Demographics
NPI:1417057639
Name:ULRIKE ENTWISTLE
Entity Type:Organization
Organization Name:ULRIKE ENTWISTLE
Other - Org Name:HEART STRINGS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ULRIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTWISTLE
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:386-427-6344
Mailing Address - Street 1:1131 N DIXIE FWY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6069
Mailing Address - Country:US
Mailing Address - Phone:386-427-6344
Mailing Address - Fax:386-427-6344
Practice Address - Street 1:1620 BREVARD RD UNIT 30
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3221
Practice Address - Country:US
Practice Address - Phone:386-847-2976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5789250001OtherPTAN