Provider Demographics
NPI:1336928563
Name:POOLER, HEATHER JUSTINA (DOM, AP, LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JUSTINA
Last Name:POOLER
Suffix:
Gender:F
Credentials:DOM, AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 6TH AVE NE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3022
Mailing Address - Country:US
Mailing Address - Phone:813-981-4276
Mailing Address - Fax:
Practice Address - Street 1:111 2ND AVE NE STE 705
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3441
Practice Address - Country:US
Practice Address - Phone:727-677-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist