Provider Demographics
NPI:1366231854
Name:HEFFERNAN, BRIANNA (RN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GRENADIER LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3717
Mailing Address - Country:US
Mailing Address - Phone:631-383-2909
Mailing Address - Fax:
Practice Address - Street 1:40 GRENADIER LN
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3717
Practice Address - Country:US
Practice Address - Phone:631-383-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY775583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse