Provider Demographics
NPI:1942374301
Name:HEATH, JENNIFER LORENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LORENE
Last Name:HEATH
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:915 E FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2816
Mailing Address - Country:US
Mailing Address - Phone:850-444-3400
Mailing Address - Fax:850-595-0096
Practice Address - Street 1:915 E FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2816
Practice Address - Country:US
Practice Address - Phone:850-444-3400
Practice Address - Fax:850-595-0096
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9103433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant