Provider Demographics
NPI:1871132670
Name:PAYNE, HEATHER D (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 CHEROKEE CV
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8270
Mailing Address - Country:US
Mailing Address - Phone:219-204-1088
Mailing Address - Fax:
Practice Address - Street 1:500 N WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-5005
Practice Address - Country:US
Practice Address - Phone:855-893-2298
Practice Address - Fax:866-214-6824
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26931363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNNAOtherNA