Individual
MISS HEATHER SALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2000 N FORSYTH RD, ORLANDO, FL 32807-5261
(407) 322-8645
(321) 275-0867
Mailing address
4930 E. LAKE MARY BLVD., SANFORD, FL 32377-5003
(407) 322-8645
(407) 330-5074
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9104734
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001924000
—
FL
01
—
01353503
AMERIGROUP
FL
01
—
541508
WELLCARE
FL
Enumeration date
05/12/2009
Last updated
07/17/2017
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