Provider Demographics
NPI:1114086030
Name:HEUSNER, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:HEUSNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 MENDOCINO LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7408
Mailing Address - Country:US
Mailing Address - Phone:201-927-6930
Mailing Address - Fax:
Practice Address - Street 1:240 N FREDERICK AVE STE B
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3413
Practice Address - Country:US
Practice Address - Phone:074-945-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052381-11041C0700X
FL2877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical