Provider Demographics
NPI:1447819974
Name:HEINECKE, ANDREW BRICE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRICE
Last Name:HEINECKE
Suffix:
Gender:M
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 1:6807 S 3200 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1828
Mailing Address - Country:US
Mailing Address - Phone:801-350-1065
Mailing Address - Fax:
Practice Address - Street 1:6807 S 3200 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1828
Practice Address - Country:US
Practice Address - Phone:801-350-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5606726-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care