Provider Demographics
NPI:1952792459
Name:HEILIG, CALLIE (APRN)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:HEILIG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:
Other - Last Name:LECROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2100 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4587
Mailing Address - Country:US
Mailing Address - Phone:850-763-0036
Mailing Address - Fax:
Practice Address - Street 1:2100 STATE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4587
Practice Address - Country:US
Practice Address - Phone:251-605-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77226363L00000X, 363LF0000X
FL11018308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114812200Medicaid