Provider Demographics
NPI:1700349834
Name:PINK, HEATHER MARIE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:PINK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 MASTHEAD ST NE STE 120
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4497
Mailing Address - Country:US
Mailing Address - Phone:505-407-2074
Mailing Address - Fax:
Practice Address - Street 1:4401 MASTHEAD ST NE STE 120
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4497
Practice Address - Country:US
Practice Address - Phone:505-407-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55619363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRN-76561OtherBOARD OF NURSING
NM55619OtherBOARD OF NURSING
F03190109OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
NMCS00227074OtherPHARMACY BOARD
NMCS00227074OtherPHARMACY BOARD