Provider Demographics
NPI:1891017125
Name:ELLIOTT DEMARS, HEATHER MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:ELLIOTT DEMARS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:DEMARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:260 BICENTENNIAL WAY APT 811
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7423
Mailing Address - Country:US
Mailing Address - Phone:603-959-8758
Mailing Address - Fax:
Practice Address - Street 1:3495 KEYSTONE LOOP
Practice Address - Street 2:
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94505-2320
Practice Address - Country:US
Practice Address - Phone:603-959-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant