Individual
HEATHER ELISE HACKSTIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9430 TURKEY LAKE RD STE 114, ORLANDO, FL 32819-8015
(407) 354-1202
(407) 351-8801
Mailing address
9430 TURKEY LAKE RD STE 114, ORLANDO, FL 32819-8015
(407) 354-1202
(407) 351-8801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA9106618
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9106618
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006488300
—
FL
Enumeration date
07/30/2012
Last updated
07/10/2025
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