Provider Demographics
NPI:1710263132
Name:FUNK, HEATHER (RNFA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7860 BERGAMO AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4761
Mailing Address - Country:US
Mailing Address - Phone:877-279-0023
Mailing Address - Fax:877-279-0025
Practice Address - Street 1:7860 BERGAMO AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4761
Practice Address - Country:US
Practice Address - Phone:877-279-0023
Practice Address - Fax:877-279-0025
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2104152163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant