Provider Demographics
NPI:1023118122
Name:SARKIS, HEATHER (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SARKIS
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 1:315 W DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8600
Mailing Address - Country:US
Mailing Address - Phone:208-209-2066
Mailing Address - Fax:208-209-2076
Practice Address - Street 1:315 W DALTON AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8600
Practice Address - Country:US
Practice Address - Phone:208-209-2066
Practice Address - Fax:208-209-2076
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP09970Medicare UPIN
ID1666704Medicare Oscar/Certification