Individual
TIFFANY C HEIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
900 N LIBERTY ST STE 201, BOISE, ID 83704-8707
(208) 367-6740
(208) 367-6742
Mailing address
PO BOX 4143, BOISE, ID 83711-4143
(208) 367-6740
(208) 367-6742
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
N-34138
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807326000
—
ID
Enumeration date
08/07/2006
Last updated
09/27/2012
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