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NPI Code Detail

MEDICARE: SUSAN R HEINRICHS PA

MEDICARE: SUSAN R HEINRICHS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA0002213FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3970004473OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y04FPOTHERFLBC/BS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922003839
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN R HEINRICHS PA
Provider Business Mailing Address
First Line : 13020 N TELECOM PKWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-0925
Country : US
Telephone Number : 813-978-9700
Fax Number : 813-972-5055
Provider Business Practice Location Address
First Line : 13020 N TELECOM PKWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-0925
Country : US
Telephone Number : 813-978-9700
Fax Number : 813-972-5055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 11/21/2011

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Directions to “ SUSAN R HEINRICHS PA” Practice Location

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