Provider Demographics
NPI:1538656715
Name:SMITH, HEATHER IRIS (MSN, FNP-C, CLT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:IRIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, FNP-C, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 W ANTHEM WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-7001
Mailing Address - Country:US
Mailing Address - Phone:480-324-7000
Mailing Address - Fax:
Practice Address - Street 1:3648 W ANTHEM WAY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-7001
Practice Address - Country:US
Practice Address - Phone:803-247-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11395363L00000X
OH126846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse