1952477366 NPI number — DR. HEATHER SHERRY-ANNE LUING MD

Table of content: DR. HEATHER SHERRY-ANNE LUING MD (NPI 1952477366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952477366 NPI number — DR. HEATHER SHERRY-ANNE LUING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUING
Provider First Name:
HEATHER
Provider Middle Name:
SHERRY-ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952477366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SOUTHPARK BLVD
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086-5179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-429-7076
Provider Business Mailing Address Fax Number:
904-217-8950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 KINGSLEY LAKE DR
Provider Second Line Business Practice Location Address:
STE 601
Provider Business Practice Location Address City Name:
SAINT AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32092-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-217-4602
Provider Business Practice Location Address Fax Number:
904-217-4427
Provider Enumeration Date:
11/28/2006

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: 2084P0800X , with the licence number:  ME95498 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106437900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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