Provider Demographics
NPI:1639667710
Name:CARLE, HEIDI M (FNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:CARLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:M
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:4710 W 191ST ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1412
Mailing Address - Country:US
Mailing Address - Phone:310-863-7126
Mailing Address - Fax:
Practice Address - Street 1:415 PIER AVE
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3820
Practice Address - Country:US
Practice Address - Phone:310-379-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006848363LF0000X
CA602993163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily