Provider Demographics
NPI:1952326910
Name:HEATHMAN, SHIRLEY MARGARET (FNP-C, PA-C)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MARGARET
Last Name:HEATHMAN
Suffix:
Gender:F
Credentials:FNP-C, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-4207
Mailing Address - Country:US
Mailing Address - Phone:760-373-8548
Mailing Address - Fax:
Practice Address - Street 1:2041 BELSHAW ST
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1601
Practice Address - Country:US
Practice Address - Phone:661-824-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12302363A00000X
CARN281528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily