Provider Demographics
NPI:1457830556
Name:SOMMERS, HEIDI JO (APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 VIA MILANO CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4118
Mailing Address - Country:US
Mailing Address - Phone:321-693-2838
Mailing Address - Fax:
Practice Address - Street 1:1131 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4110
Practice Address - Country:US
Practice Address - Phone:321-434-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9269766363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health