Provider Demographics
NPI:1184884421
Name:VANDEN HEUVEL, KELLEY (NNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:VANDEN HEUVEL
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:KUCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-8181
Mailing Address - Fax:727-767-8030
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-8181
Practice Address - Fax:727-767-8030
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX722312363LN0000X
FLARNP9323922363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y9717OtherBCBS