Provider Demographics
NPI:1447565346
Name:SPAKES, HEATHER NICOLE (CMA,NA)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:NICOLE
Last Name:SPAKES
Suffix:
Gender:F
Credentials:CMA,NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1301
Mailing Address - Country:US
Mailing Address - Phone:931-473-8468
Mailing Address - Fax:
Practice Address - Street 1:1401 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1301
Practice Address - Country:US
Practice Address - Phone:931-473-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104806457376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide