Provider Demographics
NPI:1740694835
Name:STANCIL, HEATHER NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:STANCIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:FORSYTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2136
Mailing Address - Country:US
Mailing Address - Phone:352-529-0477
Mailing Address - Fax:352-529-0406
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2136
Practice Address - Country:US
Practice Address - Phone:352-529-0477
Practice Address - Fax:352-529-0406
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9310568363L00000X
FLARNP9310568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012434100Medicaid