Tina Lisa Heck, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA20461 Issued in CA

Practice address

212 S Main St Ste 105
Templeton, CA 93465-9348

Phone

(805) 788-8129

Fax

(805) 244-0445

NPI assigned

Aug 14, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tina Lisa Pravongviengkham Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17363/brand/1/csg/1/fhir/r4
• Direct secure messaging: tina.heck.1@17363.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cep America - California

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Oceano, CA
  • NPI 1336166248
  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Porterville, CA
  • NPI 1780049080
  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • San Luis Obispo, CA
  • NPI 1275553257
  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Oceano, CA
  • NPI 1417480294
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1003048620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S MAIN ST STE 105",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659348",
            "telephone_number": "805-788-8129",
            "fax_number": "805-244-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S MAIN ST STE 105",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659348",
            "telephone_number": "805-788-8129",
            "fax_number": "805-244-0445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 Las Tablas Rd",
            "address_purpose": "LOCATION",
            "city": "Templeton",
            "state": "CA",
            "postal_code": "934659758",
            "country_code": "US",
            "telephone_number": "805-542-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HECK",
        "first_name": "TINA",
        "middle_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-14",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "PRAVONGVIENGKHAM",
            "middle_name": "LISA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lindsay Diane Hanna, NP
• George R Hansen, MD
• Thomas C Harper, MD
• Ashley Ann Hatch, RN
• Kathleen Joyce Hayes, OD
• John E Heess, MD
• Aubrey Michelle Hefner, D.C.
• Clara Jo Heinritz, L.AC.
• Hendrik Breytenbach MD Inc
• Melvin Herman, M.D.

• Physician Assistant in Templeton, CA
• Providers in Templeton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.