Provider Demographics
NPI:1982220075
Name:HEAGY, JOSEPH
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:HEAGY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 W ARDICE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6239
Mailing Address - Country:US
Mailing Address - Phone:407-616-8109
Mailing Address - Fax:
Practice Address - Street 1:11433 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4632
Practice Address - Country:US
Practice Address - Phone:352-602-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLK91504171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty