MEDICARE: HEIDI LICATA CHHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1255269783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI LICATA CHHP

Provider Business Mailing Address
First Line	:	1317 EDGEWATER DR # 2495
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 EDGEWATER DR # 2495
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:	813-543-6571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ HEIDI LICATA CHHP” Practice Location

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