Provider Demographics
NPI:1982703922
Name:HEADS, L KIRSTIN (DOM, AP)
Entity Type:Individual
Prefix:MS
First Name:L KIRSTIN
Middle Name:
Last Name:HEADS
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7604
Mailing Address - Street 2:SEBRING HEALTH & WELLNESS CENTER
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-0111
Mailing Address - Country:US
Mailing Address - Phone:863-314-9800
Mailing Address - Fax:863-582-9900
Practice Address - Street 1:2190 LAKEVIEW DR
Practice Address - Street 2:SEBRING HEALTH & WELLNESS CENTER
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4967
Practice Address - Country:US
Practice Address - Phone:863-314-9800
Practice Address - Fax:863-582-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC005COtherBCBSFL