Provider Demographics
NPI:1073898680
Name:SHARP, HEATHER LYNNEA (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNEA
Last Name:SHARP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 N HIGHLAND PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2016
Mailing Address - Country:US
Mailing Address - Phone:423-209-6070
Mailing Address - Fax:
Practice Address - Street 1:455 N HIGHLAND PARK AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2016
Practice Address - Country:US
Practice Address - Phone:423-209-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant