Provider Demographics
NPI:1245841311
Name:CONYERS, HEATHER DENISE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENISE
Last Name:CONYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E JACKSON ST STE 2340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5226
Mailing Address - Country:US
Mailing Address - Phone:813-796-5113
Mailing Address - Fax:813-796-5108
Practice Address - Street 1:401 E JACKSON ST STE 2340
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5226
Practice Address - Country:US
Practice Address - Phone:813-796-5113
Practice Address - Fax:813-796-5108
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty