Provider Demographics
NPI:1023458213
Name:VAN SLYKE, HEATHER JO (RN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JO
Last Name:VAN SLYKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:JO
Other - Last Name:TESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:527 LIGHTNING TRL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4048
Mailing Address - Country:US
Mailing Address - Phone:407-808-3864
Mailing Address - Fax:407-856-6532
Practice Address - Street 1:7000 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5749
Practice Address - Country:US
Practice Address - Phone:407-858-5555
Practice Address - Fax:407-856-6532
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9219345163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator