Provider Demographics
NPI:1356534416
Name:HEIDEL-ARNOLD, BONNIE ANN (DOM; LAC; LMT)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:ANN
Last Name:HEIDEL-ARNOLD
Suffix:
Gender:F
Credentials:DOM; LAC; LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15350 AMBERLY DRIVE
Mailing Address - Street 2:3611
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1636
Mailing Address - Country:US
Mailing Address - Phone:239-775-0212
Mailing Address - Fax:813-435-3002
Practice Address - Street 1:15350 AMBERLY DR UNIT 3611
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:239-775-0212
Practice Address - Fax:813-435-3002
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1947133N00000X, 175L00000X, 171100000X
FLMA 12560172M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12568072OtherCAQH