Provider Demographics
NPI:1780613653
Name:ANTHONY, HEATHER BROOKE JOYE (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE JOYE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:BROOKE
Other - Last Name:JOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:
Practice Address - Street 1:3510 N HIGHWAY 17 STE 320
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8232
Practice Address - Country:US
Practice Address - Phone:843-971-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0777PAMedicaid
SCAA08245282Medicare PIN
SCAA08247522Medicare PIN
SCAA08245277Medicare PIN
SCAA08247499Medicare PIN
SCAA08246834Medicare PIN
SCAA08247819Medicare PIN
SCAA08246868Medicare PIN
SCAA08247006Medicare PIN
SCAA08247126Medicare PIN
SCP00871892Medicare PIN
SCAA08246882Medicare PIN
SCAA08247498Medicare PIN
SCAA08245281Medicare PIN
SCAA08247555Medicare PIN
SCAA08248798Medicare PIN