Provider Demographics
NPI:1245268408
Name:HEATH, HEATHER TIFFANY (NP)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:TIFFANY
Last Name:HEATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S ENOTA DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3473
Mailing Address - Country:US
Mailing Address - Phone:770-534-2020
Mailing Address - Fax:770-538-7872
Practice Address - Street 1:200 S ENOTA DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3473
Practice Address - Country:US
Practice Address - Phone:770-534-2020
Practice Address - Fax:770-538-7872
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBGZLMedicare ID - Type Unspecified
GAP36332Medicare UPIN