Provider Demographics
NPI:1639461254
Name:PANTOJA, HEIDI ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:RIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1382 NW 104TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-3900
Mailing Address - Country:US
Mailing Address - Phone:754-484-4336
Mailing Address - Fax:
Practice Address - Street 1:5800 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6102
Practice Address - Country:US
Practice Address - Phone:954-377-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9264151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily