Provider Demographics
NPI:1427557750
Name:KOERNER, HEATHER JILL (AP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JILL
Last Name:KOERNER
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14146 PACIFIC POINT PL APT 105
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1886
Mailing Address - Country:US
Mailing Address - Phone:772-480-6578
Mailing Address - Fax:
Practice Address - Street 1:301 CRAWFORD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3762
Practice Address - Country:US
Practice Address - Phone:772-480-6578
Practice Address - Fax:772-480-6578
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty