Individual
HEATHER TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6006 49TH ST N STE 200, ST PETERSBURG, FL 33709-2149
(727) 490-2100
Mailing address
6006 49TH ST N STE 200, ST PETERSBURG, FL 33709-2149
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9110573
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022885000
—
FL
Enumeration date
09/21/2017
Last updated
08/29/2019
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