Individual provider Active NPI

Demetra Latrice Tate-Heilman, PA

  • Physician Assistant
  • Virginia Beach, VA
National Provider Identifier
1619021250
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110002414 Issued in VA
Practice address
1060 First Colonial Rd
Virginia Beach, VA 23454-3002
Phone
(757) 395-2323
NPI assigned
Jan 22, 2007
Last updated
Jun 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110002414 VA Primary

Addresses

Primary practice location

1060 First Colonial Rd
Virginia Beach, VA 23454-3002

Mailing address

2800 Godwin Blvd
Suffolk, VA 23434-8038
Phone (757) 934-4821

Other practice location 1

225 Clearfield Ave
Virginia Beach, VA 23462-1815
Phone (757) 457-5100 ext. 3782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20070620000442 VA Practitioner - Physician Assistant 3971602731 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110002414VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group CurrentSince Jan 11, 2016 Accepting new patients
Urology of Virginia, PLLC Current Accepting new patients
Riverside Physician Services Inc Past Accepting new patients

Locations

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

2800 Godwin Blvd
Suffolk, VA 23434
Phone (757) 934-4000

1060 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 395-2323

225 Clearfield Ave
Virginia Beach, VA 23462
Phone (757) 452-3459

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1619021250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 GODWIN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348038",
            "telephone_number": "757-934-4821",
            "fax_number": "757-934-4276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 FIRST COLONIAL RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543002",
            "telephone_number": "757-395-2323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Clearfield Ave",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234621815",
            "country_code": "US",
            "telephone_number": "757-457-5100 x3782",
            "fax_number": "757-961-3696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATE-HEILMAN",
        "first_name": "DEMETRA",
        "middle_name": "LATRICE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.