Provider Demographics
NPI:1144650417
Name:FOULKE, HEATHER J (CNM)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:J
Last Name:FOULKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 ROVER WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9374
Mailing Address - Country:US
Mailing Address - Phone:717-250-5966
Mailing Address - Fax:
Practice Address - Street 1:391 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5271
Practice Address - Country:US
Practice Address - Phone:786-453-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018052367A00000X
MI4704254732367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife