Provider Demographics
NPI:1467725523
Name:HETRICK, ERICA DANIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DANIELLE
Last Name:HETRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1248
Mailing Address - Country:US
Mailing Address - Phone:407-303-2528
Mailing Address - Fax:407-303-2760
Practice Address - Street 1:601 E ROLLINS STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1468
Practice Address - Country:US
Practice Address - Phone:607-303-2528
Practice Address - Fax:407-895-8279
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9227417363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09YXOtherBLUE CROSS BLUE SHIELD
FL004641100Medicaid