Provider Demographics
NPI:1710744776
Name:HEATWOLE, LAURENCE (APRN)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:HEATWOLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8078 SAW PALMETTO LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1428
Mailing Address - Country:US
Mailing Address - Phone:561-398-8830
Mailing Address - Fax:
Practice Address - Street 1:8078 SAW PALMETTO LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1428
Practice Address - Country:US
Practice Address - Phone:561-398-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031318363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty