Provider Demographics
NPI:1336595438
Name:THOMPSON, HEATHER JANE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4414
Mailing Address - Country:US
Mailing Address - Phone:850-361-9610
Mailing Address - Fax:
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:727-845-1736
Practice Address - Fax:727-849-0759
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9284174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered