Provider Demographics
NPI:1700426251
Name:LOCKE, HEATHER (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 BELFORT RD STE 352
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1407
Mailing Address - Country:US
Mailing Address - Phone:904-372-3943
Mailing Address - Fax:
Practice Address - Street 1:4190 BELFORT RD STE 352
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1407
Practice Address - Country:US
Practice Address - Phone:904-372-3943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1175233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily