Healthcare Provider Details

I. General information

NPI: 1124572011
Provider Name (Legal Business Name): HEATHER AYNNE VERNILLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 ALT 19 SUITE B4
PALM HARBOR FL
34683-1929
US

IV. Provider business mailing address

3060 ALT 19 SUITE B4
PALM HARBOR FL
34683-1929
US

V. Phone/Fax

Practice location:
  • Phone: 727-342-0155
  • Fax: 888-561-5898
Mailing address:
  • Phone: 727-342-0155
  • Fax: 888-561-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9330256
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9330256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: