Provider Demographics
NPI:1699017962
Name:POLMONARI, HEATHER H (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:H
Last Name:POLMONARI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:MICHELLE
Other - Last Name:HAMBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3091 KIRBY WHITTEN PKWY
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-759-4704
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN164008363LA2200X
TN17415363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health