Provider Demographics
NPI:1215947957
Name:HEATH, DIANA HEATHER (MD FACS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:HEATHER
Last Name:HEATH
Suffix:
Gender:F
Credentials:MD FACS
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Mailing Address - Street 1:1109 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-5638
Mailing Address - Country:US
Mailing Address - Phone:727-934-5705
Mailing Address - Fax:727-937-3756
Practice Address - Street 1:1109 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5638
Practice Address - Country:US
Practice Address - Phone:727-934-5705
Practice Address - Fax:727-937-3756
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME60846207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3726151000Medicaid
FLE97957Medicare UPIN
FL3726151000Medicaid