Provider Demographics
NPI:1588218663
Name:HEYWARD, CHARLISA (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:CHARLISA
Middle Name:
Last Name:HEYWARD
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17450 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6262
Mailing Address - Country:US
Mailing Address - Phone:909-701-7157
Mailing Address - Fax:
Practice Address - Street 1:17450 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6262
Practice Address - Country:US
Practice Address - Phone:760-493-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012553363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty