Provider Demographics
NPI:1275823593
Name:BEAL, HEIDI M (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:BEAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 AVELAR RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578
Mailing Address - Country:US
Mailing Address - Phone:216-647-4594
Mailing Address - Fax:813-671-5492
Practice Address - Street 1:10303 AVELAR RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578
Practice Address - Country:US
Practice Address - Phone:216-647-4594
Practice Address - Fax:813-671-5492
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9319196163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis