Provider Demographics
NPI:1518213453
Name:SELIGMAN, HEATHER ELISE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELISE
Last Name:SELIGMAN
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 1:2500 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3501
Mailing Address - Country:US
Mailing Address - Phone:407-383-2486
Mailing Address - Fax:407-936-0977
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-383-2486
Practice Address - Fax:407-936-0977
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical