Provider Demographics
NPI:1114742871
Name:ERICKSON, HEIDI (PNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ESTRELLA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1604
Mailing Address - Country:US
Mailing Address - Phone:530-966-5697
Mailing Address - Fax:
Practice Address - Street 1:2486 N PONDEROSA DR STE D211
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2470
Practice Address - Country:US
Practice Address - Phone:805-484-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030689363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics