Provider Demographics
NPI:1659661874
Name:HEERSINK, JUANITA TITRUD (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:TITRUD
Last Name:HEERSINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 WESLEY WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-2004
Mailing Address - Country:US
Mailing Address - Phone:334-479-0007
Mailing Address - Fax:334-479-0023
Practice Address - Street 1:3113 WESLEY WAY STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-2004
Practice Address - Country:US
Practice Address - Phone:334-479-0007
Practice Address - Fax:334-479-0057
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32100207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine