Provider Demographics
NPI:1518246990
Name:FREED, HEATHER LEE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LEE
Last Name:FREED
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HOBBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:600 N CATTLEMEN RD STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-377-9993
Practice Address - Fax:941-343-0026
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9255947363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005573200Medicaid