Provider Demographics
NPI:1720642945
Name:HECKMANN, JENNIFER SOPHIA (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SOPHIA
Last Name:HECKMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SOPHIA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:548 JACOB WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2284
Mailing Address - Country:US
Mailing Address - Phone:423-443-9961
Mailing Address - Fax:
Practice Address - Street 1:1083 SUNCREST DR STE A
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4421
Practice Address - Country:US
Practice Address - Phone:810-245-9700
Practice Address - Fax:810-245-9703
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant