Provider Demographics
NPI:1922034354
Name:TALBOT, HEATHER GREEN (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:GREEN
Last Name:TALBOT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-990-1950
Mailing Address - Fax:251-990-1951
Practice Address - Street 1:188 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-1950
Practice Address - Fax:251-990-1951
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1093964363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q68676Medicare UPIN
AL051557538Medicare PIN