Provider Demographics
NPI:1598761165
Name:NAGEL, HEATHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:S
Last Name:NAGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 11TH CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4804
Mailing Address - Country:US
Mailing Address - Phone:772-562-0163
Mailing Address - Fax:
Practice Address - Street 1:3725 11TH CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4804
Practice Address - Country:US
Practice Address - Phone:772-562-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME640262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373771300Medicaid
FL18976OtherBLUE CROSS & BLUE SHIELD
FL18976OtherBLUE CROSS & BLUE SHIELD
FLF56758Medicare UPIN
FL373771300Medicaid