Provider Demographics
NPI:1558538306
Name:INNER GLOW HEALING
Entity Type:Organization
Organization Name:INNER GLOW HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-642-7695
Mailing Address - Street 1:3775 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-1321
Mailing Address - Country:US
Mailing Address - Phone:727-642-7695
Mailing Address - Fax:
Practice Address - Street 1:7310 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1119
Practice Address - Country:US
Practice Address - Phone:727-642-7695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service