Provider Demographics
NPI:1740414275
Name:SALES, HEATHER (PA-C)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:
Last Name:SALES
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 1:4930 E. LAKE MARY BLVD.
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32377-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:2000 N FORSYTH RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-5261
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:321-275-0867
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL541508OtherWELLCARE
FL001924000Medicaid
FL01353503OtherAMERIGROUP
FL01353503OtherAMERIGROUP