Provider Demographics
NPI:1063423291
Name:WELCH, HEATHER A (ARNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:WELCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1368 HOLLY GLEN RUN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6863
Mailing Address - Country:US
Mailing Address - Phone:407-873-5021
Mailing Address - Fax:
Practice Address - Street 1:7051 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5140
Practice Address - Country:US
Practice Address - Phone:407-363-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1856642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301644700Medicaid
FL259038700OtherMEDICAID GROUP NUMBER
FL24039OtherMEDICARE GROUP NUMBER
FL301644700Medicaid
FL24039OtherMEDICARE GROUP NUMBER