Provider Demographics
NPI:1467288548
Name:EBERLEIN, HEATHER (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:EBERLEIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 HEMLOCK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6889
Mailing Address - Country:US
Mailing Address - Phone:478-755-1560
Mailing Address - Fax:
Practice Address - Street 1:639 HEMLOCK ST STE 100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6889
Practice Address - Country:US
Practice Address - Phone:478-755-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily