Provider Demographics
NPI:1518924208
Name:SZYMCZAK, HEATHER L (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:SZYMCZAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2374 VILLAGE COMMON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7201
Mailing Address - Country:US
Mailing Address - Phone:814-833-7246
Mailing Address - Fax:814-833-1147
Practice Address - Street 1:2374 VILLAGE COMMON DR STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7201
Practice Address - Country:US
Practice Address - Phone:814-833-7246
Practice Address - Fax:814-833-1147
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2413363AM0700X
PAMA051276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340726081OtherTAX IDENTIFICATION
PA261827801OtherTAX IDENTIFICATION