Provider Demographics
NPI:1255137469
Name:HEREDIA, ISABEL CRISTINA (RN)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:CRISTINA
Last Name:HEREDIA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 SHEER BLISS WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-0026
Mailing Address - Country:US
Mailing Address - Phone:305-744-1311
Mailing Address - Fax:
Practice Address - Street 1:3024 SHEER BLISS WAY
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-0026
Practice Address - Country:US
Practice Address - Phone:305-744-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9403398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse