Provider Demographics
NPI:1699234195
Name:MARVIN, HEATHER A (APRN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:MARVIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 GANNETT RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1725
Mailing Address - Country:US
Mailing Address - Phone:815-272-6100
Mailing Address - Fax:
Practice Address - Street 1:1038 GANNETT RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1725
Practice Address - Country:US
Practice Address - Phone:815-272-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019014363LF0000X
TNAPN0000034345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily