Provider Demographics
NPI:1265872766
Name:HEATON, EMILY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:HEATON
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 1:1931 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5314
Mailing Address - Country:US
Mailing Address - Phone:850-215-7093
Mailing Address - Fax:850-215-7096
Practice Address - Street 1:1931 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5314
Practice Address - Country:US
Practice Address - Phone:850-215-7093
Practice Address - Fax:850-215-7096
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-901363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical