Provider Demographics
NPI:1386115178
Name:LAZOS, HEIDI JOY (AGNP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JOY
Last Name:LAZOS
Suffix:
Gender:F
Credentials:AGNP
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:1000 OLD DENBIGH BLVD # 1020A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-2017
Practice Address - Country:US
Practice Address - Phone:757-875-2009
Practice Address - Fax:757-369-1042
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
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Provider Licenses
StateLicense IDTaxonomies
VA0024176874363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology