Provider Demographics
NPI:1679253124
Name:HELLER, MEGAN (FNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 FRUITVILLE RD UNIT 207
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1881
Mailing Address - Country:US
Mailing Address - Phone:808-346-6709
Mailing Address - Fax:
Practice Address - Street 1:4825 FRUITVILLE RD UNIT 207
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1881
Practice Address - Country:US
Practice Address - Phone:808-346-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily