Healthcare Provider Details

I. General information

NPI: 1679482053
Provider Name (Legal Business Name): TINA HECK PHYSICIAN ASSISTANT, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MAIN ST STE 105
TEMPLETON CA
93465-9348
US

IV. Provider business mailing address

212 S MAIN ST STE 105
TEMPLETON CA
93465-9348
US

V. Phone/Fax

Practice location:
  • Phone: 805-788-8129
  • Fax: 805-244-0445
Mailing address:
  • Phone: 805-788-8129
  • Fax: 805-244-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: TINA HECK
Title or Position: PRESIDENT
Credential: PA
Phone: 805-788-8129