Provider Demographics
NPI:1568615318
Name:KOSTOFF, HEATHER ANNE (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:KOSTOFF
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 850
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-0850
Mailing Address - Country:US
Mailing Address - Phone:832-998-1510
Mailing Address - Fax:866-845-0933
Practice Address - Street 1:2701 MORGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1848
Practice Address - Country:US
Practice Address - Phone:361-452-0799
Practice Address - Fax:877-587-6802
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697589363L00000X
TXAP115034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner