Provider Demographics
NPI:1720042393
Name:HEINZ, JEANA MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:JEANA
Middle Name:MARIE
Last Name:HEINZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17345 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4210
Mailing Address - Country:US
Mailing Address - Phone:954-732-1222
Mailing Address - Fax:954-430-6140
Practice Address - Street 1:17345 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-4210
Practice Address - Country:US
Practice Address - Phone:954-732-1222
Practice Address - Fax:954-430-6140
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291405100Medicaid
FLP43809Medicare UPIN
FL291405100Medicaid