Provider Demographics
NPI:1720415086
Name:MCTIGUE, HEATHER C (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:MCTIGUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:KOCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 STATE ROUTE 31 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4069
Mailing Address - Country:US
Mailing Address - Phone:908-847-3100
Mailing Address - Fax:866-276-9292
Practice Address - Street 1:315 STATE ROUTE 31 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4069
Practice Address - Country:US
Practice Address - Phone:908-847-3100
Practice Address - Fax:866-276-9292
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0451649Medicaid
NJ341172Medicare PIN