# HEARTLAND SURGICAL ASSISTANTS, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689764763
- **Authorized official:** KEVIN K CARLISLE PAC (PRESIDENT)
- **Authorized official phone:** (863) 381-7632

## Contact information

- **Practice address:** 200 AVENUE F NE, WINTER HAVEN, FL 33881-4131
- **Practice address phone:** (863) 381-7647
- **Mailing address:** 5112 LAKE DEESON WOODS CT, LAKELAND, FL 33805-7638
- **Mailing address phone:** (863) 381-7632
- **Mailing address fax:** (863) 606-5713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA1682 | FL | Yes |

## Other

- **Enumeration date:** 10/13/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DA4132 | RAILROAD MEDICARE | FL |
| 01 | — | X1592 | BCBS | FL |