Provider Demographics
NPI:1184066904
Name:HOLLERAN, HEATHER (PA-C, MSHS, MPH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HOLLERAN
Suffix:
Gender:F
Credentials:PA-C, MSHS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 W GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4529
Mailing Address - Country:US
Mailing Address - Phone:480-205-6377
Mailing Address - Fax:
Practice Address - Street 1:1626 S PRIEST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6204
Practice Address - Country:US
Practice Address - Phone:480-882-7320
Practice Address - Fax:480-967-7920
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5438363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant