Provider Demographics
NPI:1659539740
Name:POGAR, HEATHER M (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:POGAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1653 JESS PARRISH CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2145
Mailing Address - Country:US
Mailing Address - Phone:321-267-5965
Mailing Address - Fax:321-267-8487
Practice Address - Street 1:1653 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2145
Practice Address - Country:US
Practice Address - Phone:321-267-5965
Practice Address - Fax:321-267-8487
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9248553363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics