Provider Demographics
NPI:1477958254
Name:HECK, TINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:HECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425 82 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:ISLAND POND
Mailing Address - State:VT
Mailing Address - Zip Code:05846
Mailing Address - Country:US
Mailing Address - Phone:802-723-4300
Mailing Address - Fax:
Practice Address - Street 1:82 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ISLAND POND
Practice Address - State:VT
Practice Address - Zip Code:05846
Practice Address - Country:US
Practice Address - Phone:802-723-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0107042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily