Provider Demographics
NPI:1922119601
Name:WHITWORTH, HEATHER SAMMONS (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:SAMMONS
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:SAMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4488
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:435 2ND ST NE
Practice Address - Street 2:NEMOURS CHILDRENS PRIMARY CARE, KINDER CLINIC
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4103
Practice Address - Country:US
Practice Address - Phone:863-299-4567
Practice Address - Fax:863-297-9750
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072535174400000X
FLME72535208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist