Provider Demographics
NPI:1215533021
Name:HEISLER, SANDRA KAY
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:HEISLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 MOUNT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1757
Mailing Address - Country:US
Mailing Address - Phone:863-430-7805
Mailing Address - Fax:
Practice Address - Street 1:1260 GOLFVIEW AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6738
Practice Address - Country:US
Practice Address - Phone:863-519-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily