Provider Demographics
NPI:1104090356
Name:FLANAGAN, HEATHER ERIN (ARNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ERIN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MEDICAL CARE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5937
Mailing Address - Country:US
Mailing Address - Phone:813-684-2506
Mailing Address - Fax:813-684-5785
Practice Address - Street 1:608 MEDICAL CARE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5937
Practice Address - Country:US
Practice Address - Phone:813-684-2506
Practice Address - Fax:813-684-5785
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 92235766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner