Provider Demographics
NPI:1053023903
Name:TOLL, HEIDI GERLINDE (RN, CPN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:GERLINDE
Last Name:TOLL
Suffix:
Gender:F
Credentials:RN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 E SOUTHLAKE BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7065
Mailing Address - Country:US
Mailing Address - Phone:817-888-6974
Mailing Address - Fax:
Practice Address - Street 1:771 E SOUTHLAKE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7065
Practice Address - Country:US
Practice Address - Phone:817-888-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773883163W00000X, 163WM0705X, 163WP0200X, 163WP0218X, 163WP0807X
TX770298163W00000X, 163WM0705X, 163WP0200X, 163WN0002X, 163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent