Provider Demographics
NPI:1497261754
Name:FREEMAN, HEATHER VIRGINIA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:VIRGINIA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:VIRGINIA
Other - Last Name:BREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3109 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5548
Mailing Address - Country:US
Mailing Address - Phone:863-386-0786
Mailing Address - Fax:
Practice Address - Street 1:21550 ANGELA LN
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2017
Practice Address - Country:US
Practice Address - Phone:941-493-7400
Practice Address - Fax:941-493-1940
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty