Provider Demographics
NPI:1780871053
Name:JONES-CADDY, HEATHER (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:JONES-CADDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:JONES-CADDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:SUITE 215, WEST TOWER
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-662-3777
Mailing Address - Fax:813-685-1272
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 215 WEST TOWER
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-662-3777
Practice Address - Fax:813-685-1272
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001259600Medicaid
FL0012569601Medicaid
FLAH860VMedicare PIN
FLAH86OTMedicare PIN