Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP1696532 | FL |
NPI | 1043258635 |
---|---|
Provider Name | Melinda L Anderson Heim |
First Address | Pensacola, FL 32514-6028 |
Second Address | Pensacola, FL 32514-6028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 01/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302977800 | (05) | FL |
S53476 | (02) | |
Y9259 | BSFL (01) | FL |