Provider Demographics
NPI:1255772281
Name:PROKOFIEV, HEIDI IRENE (APN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:IRENE
Last Name:PROKOFIEV
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:IRENE
Other - Last Name:FEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:3575 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1271
Mailing Address - Country:US
Mailing Address - Phone:609-631-2839
Mailing Address - Fax:
Practice Address - Street 1:3575 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1271
Practice Address - Country:US
Practice Address - Phone:609-631-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22658666163W00000X
NJ26NJ00501600363LP0200X
NJ26NR17126100163W00000X
PARN657712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse