Provider Demographics
NPI:1861458473
Name:HEATH, STEPHANIE ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:HEATH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10804 SNOWMASS CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6707
Mailing Address - Country:US
Mailing Address - Phone:804-346-1025
Mailing Address - Fax:
Practice Address - Street 1:3600 WOODS WAY
Practice Address - Street 2:
Practice Address - City:STATE FARM
Practice Address - State:VA
Practice Address - Zip Code:23160-0002
Practice Address - Country:US
Practice Address - Phone:804-598-4251
Practice Address - Fax:804-598-8354
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS79478Medicare UPIN