Provider Demographics
NPI:1629400544
Name:MUDD, HEATHER (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MUDD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 HERITAGE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1214
Mailing Address - Country:US
Mailing Address - Phone:850-443-1822
Mailing Address - Fax:850-644-4251
Practice Address - Street 1:FSU UNIVERSITY HEALTH SERVICES 960 LEARNING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-3426
Practice Address - Country:US
Practice Address - Phone:850-209-5880
Practice Address - Fax:850-644-4251
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9365905363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily