Provider Demographics
NPI:1184124091
Name:DAVIS, HEIDI JOLENE (FNP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JOLENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3583 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5002
Mailing Address - Country:US
Mailing Address - Phone:843-357-4357
Mailing Address - Fax:843-357-4359
Practice Address - Street 1:3583 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5002
Practice Address - Country:US
Practice Address - Phone:843-357-4357
Practice Address - Fax:843-357-4359
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily