Provider Demographics
NPI:1316936347
Name:BLANCHETTE, HEATHER D (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:LEHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:100 HIGHLAND AVE N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2542
Practice Address - Country:US
Practice Address - Phone:727-683-2900
Practice Address - Fax:727-683-2901
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3284982363L00000X
FLARNP3284982363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00657715OtherMEDICARE RR
FL307343200Medicaid
FL1168350001Medicare NSC
FLAD652YMedicare PIN