Provider Demographics
NPI:1831442722
Name:COHEN, HEIDI M (PNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:COHEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:M
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7112 ED BLUESTEIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2913
Mailing Address - Country:US
Mailing Address - Phone:512-744-6000
Mailing Address - Fax:
Practice Address - Street 1:7112 ED BLUESTEIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2913
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:512-583-5462
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688656163W00000X
TXAP122499363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309377501Medicaid
TXTXB166220Medicare PIN