Provider Demographics
NPI:1225198286
Name:NIECE, HEATHER S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:S
Last Name:NIECE
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 1:8727 BRIERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4814
Mailing Address - Country:US
Mailing Address - Phone:904-305-8502
Mailing Address - Fax:
Practice Address - Street 1:4863 PALM COAST PKWY NW UNIT 2
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3665
Practice Address - Country:US
Practice Address - Phone:386-222-7746
Practice Address - Fax:386-310-2381
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004936363AM0700X
FLPA9110084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS91247Medicare UPIN