Provider Demographics
NPI:1225511660
Name:HEATH, JARED D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:D
Last Name:HEATH
Suffix:
Gender:M
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 1:7 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2637
Mailing Address - Country:US
Mailing Address - Phone:860-653-2382
Mailing Address - Fax:
Practice Address - Street 1:7 MILL POND RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2637
Practice Address - Country:US
Practice Address - Phone:860-653-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant