Provider Demographics
NPI:1851694269
Name:GALL, HEATHER MARIE (APRN, FNP-BC, MSN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:GALL
Suffix:
Gender:F
Credentials:APRN, FNP-BC, MSN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:FESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:2310 VILLAGE SQUARE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6409
Practice Address - Country:US
Practice Address - Phone:904-264-6404
Practice Address - Fax:904-390-7455
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9422503363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017186200Medicaid
FL017186200Medicaid