Provider Demographics
NPI:1649381880
Name:SVENSON, HEATHER WILFONG (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:WILFONG
Last Name:SVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13626 SHIPWATCH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5402
Mailing Address - Country:US
Mailing Address - Phone:912-399-3824
Mailing Address - Fax:
Practice Address - Street 1:4215 PLANTATION OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3641
Practice Address - Country:US
Practice Address - Phone:904-633-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050841208000000X
FLME119017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA649597456BMedicaid
GA649597456AMedicaid
GA000926087CMedicaid