Provider Demographics
NPI:1134218720
Name:HEAGY, ERICA J (FNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:HEAGY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 PIPER ST STE U466
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6905
Mailing Address - Country:US
Mailing Address - Phone:907-569-1333
Mailing Address - Fax:907-569-1433
Practice Address - Street 1:3851 PIPER ST STE U466
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6905
Practice Address - Country:US
Practice Address - Phone:907-569-1333
Practice Address - Fax:907-569-1433
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550015NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9657263Medicaid
AK1734318Medicaid
OR023082Medicaid
OR134090Medicare ID - Type Unspecified
ORP00709426Medicare PIN
ORQ52418Medicare UPIN