Healthcare Provider Details

I. General information

NPI: 1801472956
Provider Name (Legal Business Name): ALTERNATIVE APPROACH HOLISTIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CRYSTAL GROVE SAME BUILDING AS PEARL INSTITUTE FOR HEADACHE AND NEURO
LUTZ FL
33548-3361
US

IV. Provider business mailing address

801 ATTACHE CT
TAMPA FL
33613-2109
US

V. Phone/Fax

Practice location:
  • Phone: 239-775-0212
  • Fax: 813-435-3002
Mailing address:
  • Phone: 239-775-0212
  • Fax: 813-435-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DR. BONNIE A. HEIDEL-ARNOLD
Title or Position: OWNER
Credential: DOM
Phone: 239-775-0212