Provider Demographics
NPI:1578984167
Name:HILL, HEATHER LEA (ANP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEA
Last Name:HILL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEA
Other - Last Name:HILLEBRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:333 THALIA ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2713
Mailing Address - Country:US
Mailing Address - Phone:949-499-0577
Mailing Address - Fax:
Practice Address - Street 1:333 THALIA ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2713
Practice Address - Country:US
Practice Address - Phone:949-499-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95022865363LA2200X
NC5006692363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH006C115OtherMEDICARE PTAN
NC1578984167Medicaid