Provider Demographics
NPI:1447417076
Name:HEITZLER, JOAN E (ARNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:HEITZLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:E
Other - Last Name:FALINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:13417 US HIGHWAY 301
Practice Address - Street 2:STE. A
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5446
Practice Address - Country:US
Practice Address - Phone:352-567-5136
Practice Address - Fax:813-355-5038
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1559622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00998715OtherRR MEDICARE
FL002011800Medicaid
FLAK273YMedicare PIN