Individual
CODY JANTON HEINTZELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
270 SUSQUEHANNA VALLEY MALL DR STE 800, SELINSGROVE, PA 17870-9124
(570) 884-7925
(570) 374-7932
Mailing address
1 MEMORIAL MEDICAL PKWY STE 101, PALM COAST, FL 32164-5979
(386) 586-1523
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA059718
PA
363A00000X
Physician Assistant
Primary
PA9121574
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103601590
—
PA
01
—
704830
MEDICARE
PA
Enumeration date
10/16/2017
Last updated
04/01/2026
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