Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 722312 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | ARNP9323922 | FL |
NPI | 1184884421 |
---|---|
Provider Name | Kelley Vanden Heuvel |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 16/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8Y9717 | BCBS (01) | TX |