Provider Demographics
NPI:1316022684
Name:HECKMAN, CHRISTA NICOLE (PA-C, MPAS)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:NICOLE
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:MRS
Other - First Name:CHRISTA
Other - Middle Name:NICOLE
Other - Last Name:SADRZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC, MPAS
Mailing Address - Street 1:45 W. 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-471-2623
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY AVE W FL 6
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-232-2273
Practice Address - Fax:651-232-4953
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10926363AS0400X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42083Medicare UPIN
162710QMedicare ID - Type Unspecified