Provider Demographics
NPI:1912965120
Name:HEATH, ANGELA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:HEATH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:PELANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2300 RAMSEY ST
Mailing Address - Street 2:FAYETTEVILLE VA MEDICAL CENTER
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:910-488-2120
Mailing Address - Fax:910-482-5284
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:FAYETTEVILLE VA MEDICAL CENTER
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:910-482-5284
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN