Healthcare Provider Details

I. General information

NPI: 1417958794
Provider Name (Legal Business Name): HEATHER A SCHWENK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CATTLEMEN RD SUITE 200
SARASOTA FL
34232-6422
US

IV. Provider business mailing address

PO BOX 102222 ATTN: CREDENTIALING
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 941-377-9993
  • Fax: 941-343-0026
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: