Provider Demographics
NPI:1316975808
Name:CRAWFORD, HEATHER NICHOLE (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICHOLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-2340
Mailing Address - Fax:
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:340
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-2340
Practice Address - Fax:850-416-2338
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01633283Medicaid
LA2129112Medicaid
AL59185123OtherBLUE CROSS
LA57061PD91Medicare PIN
MS01633283Medicaid