Provider Demographics
NPI:1730620295
Name:DAMON, HEATHER (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DAMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:HEATHER
Other - Last Name:DAMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:305 S OCEAN DR APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-3289
Mailing Address - Country:US
Mailing Address - Phone:772-577-8577
Mailing Address - Fax:
Practice Address - Street 1:305 S OCEAN DR APT 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34949-3289
Practice Address - Country:US
Practice Address - Phone:772-577-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9268637163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse