Provider Demographics
NPI:1962028183
Name:DUNCAN -SPENCER, HEATHER JAVA
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JAVA
Last Name:DUNCAN -SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 NW 60TH TER APT 137
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1232
Mailing Address - Country:US
Mailing Address - Phone:954-305-4212
Mailing Address - Fax:
Practice Address - Street 1:2904 NW 60TH TER APT 137
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-1232
Practice Address - Country:US
Practice Address - Phone:954-305-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities