Provider Demographics
NPI:1922632975
Name:PARKER, HEIDI ANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 E SOUTHERN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5521
Mailing Address - Country:US
Mailing Address - Phone:480-325-8173
Mailing Address - Fax:480-325-8179
Practice Address - Street 1:3155 E SOUTHERN AVE STE 203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5521
Practice Address - Country:US
Practice Address - Phone:480-325-8173
Practice Address - Fax:480-325-8179
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner