1164411708 NPI number — MS. HEATHER JEAN STALKER M.SC., C.G.C.

Table of content: MS. HEATHER JEAN STALKER M.SC., C.G.C. (NPI 1164411708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164411708 NPI number — MS. HEATHER JEAN STALKER M.SC., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STALKER
Provider First Name:
HEATHER
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.SC., C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164411708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5916 NW 158TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALACHUA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32615-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-331-4586
Provider Business Mailing Address Fax Number:
352-392-3051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DIVISION OF PEDIATRIC GENETICS, UNIVERSITY OF FLORIDA
Provider Second Line Business Practice Location Address:
BOX 100296
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-0296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-392-8032
Provider Business Practice Location Address Fax Number:
352-392-3051
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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