Individual
BEVERLY ANN HEINKING
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
300 PINEWOOD DR SW, LIVE OAK, FL 32064-4029
(386) 362-1014
(386) 362-5076
Mailing address
300 PINEWOOD DR SW, LIVE OAK, FL 32064-4029
(386) 362-1014
(386) 362-5076
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS5866
FL
207Q00000X
Family Medicine Physician
R9F01
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80431
B/C
FL
Enumeration date
01/19/2006
Last updated
07/08/2007
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