Individual provider · Type 1 NPI

Heather Nunnelly, PA-C

Surgical Physician Assistant · Fort Lauderdale, FL

NPI number 1114458122 Active

Practice location

1600 S Andrews Ave Ste 101
Fort Lauderdale, FL 33316-2510

Fax (954) 355-4889

Mailing address

1608 SE 3rd Ave Fl 3
Fort Lauderdale, FL 33316-2564

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA9109811 (FL)

Surgical Physician Assistant: Definition to come...

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About NPI 1114458122

Heather Nunnelly, PA-C's National Provider Identifier is 1114458122, issued on Mar 22, 2017. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Fort Lauderdale, FL. The record was last updated on Oct 20, 2025.