Provider Demographics
NPI:1063910057
Name:FLYNN, HEATHER BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5428
Mailing Address - Country:US
Mailing Address - Phone:850-878-5310
Mailing Address - Fax:
Practice Address - Street 1:1723 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5428
Practice Address - Country:US
Practice Address - Phone:850-878-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209302163W00000X, 363LF0000X
FLAPRN11028001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003203290AMedicaid