Provider Demographics
NPI:1972756229
Name:GORDON, HEATHER KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAY
Last Name:GORDON
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 1:2625 COLLINS AVE
Mailing Address - Street 2:#1104
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4746
Mailing Address - Country:US
Mailing Address - Phone:706-495-0431
Mailing Address - Fax:
Practice Address - Street 1:160 NW 170TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5521
Practice Address - Country:US
Practice Address - Phone:706-495-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT 9104789363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical