Provider Demographics
NPI:1932784402
Name:HEFFNER, JACQUELINE (CRNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8891
Mailing Address - Country:US
Mailing Address - Phone:148-452-6289
Mailing Address - Fax:
Practice Address - Street 1:34 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1927
Practice Address - Country:US
Practice Address - Phone:570-645-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner