Healthcare Provider Details

I. General information

NPI: 1366726986
Provider Name (Legal Business Name): HEATHER M GATES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER M HOLLAND PA-C

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 LAUREL MANOR DR STE 224
THE VILLAGES FL
32162-5602
US

IV. Provider business mailing address

1950 LAUREL MANOR DR STE 224
THE VILLAGES FL
32162-5602
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-6565
  • Fax: 352-205-7777
Mailing address:
  • Phone: 352-399-7295
  • Fax: 352-399-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: