Provider Demographics
NPI:1710965843
Name:STROH, HEATHER (CNM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STROH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4614
Mailing Address - Country:US
Mailing Address - Phone:850-431-5714
Mailing Address - Fax:850-431-6403
Practice Address - Street 1:1301 HODGES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4614
Practice Address - Country:US
Practice Address - Phone:850-431-5714
Practice Address - Fax:850-431-6403
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159084176B00000X
FLARNP9318311367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA813678553AMedicaid
GA813678553BMedicaid
GA813678553AMedicaid
GA813678553BMedicaid