Provider Demographics
NPI:1861984395
Name:JOACHIM, HEATHER LYNNE (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNE
Last Name:JOACHIM
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 1:6108 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4019
Mailing Address - Country:US
Mailing Address - Phone:865-635-9464
Mailing Address - Fax:
Practice Address - Street 1:9325 S NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6548
Practice Address - Country:US
Practice Address - Phone:865-330-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF05180723163W00000X
CANP95009238363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV812324OtherNEVADA BOARD OF NURSING
TN26731OtherSTATE OF TENNESSEE
CANP95009238OtherCA LICENSE