Provider Demographics
NPI:1285398578
Name:SMART, HEATHER RENE (NP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENE
Last Name:SMART
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 CANOGA AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6567
Mailing Address - Country:US
Mailing Address - Phone:805-857-7924
Mailing Address - Fax:
Practice Address - Street 1:18321 VENTURA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4253
Practice Address - Country:US
Practice Address - Phone:818-776-0660
Practice Address - Fax:818-776-8620
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614488163W00000X
CANP950025440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse