Provider Demographics
NPI:1659877553
Name:CASILLAS, HEIDI ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ANN
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1885 43RD ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-4604
Mailing Address - Country:US
Mailing Address - Phone:708-289-0529
Mailing Address - Fax:
Practice Address - Street 1:1200 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1300
Practice Address - Country:US
Practice Address - Phone:727-825-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-01
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9224711163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine