Healthcare Provider Details

I. General information

NPI: 1720916711
Provider Name (Legal Business Name): HEATHER WILKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 BEACHWALK SHORE DR STE 102 PMB 1031
SAINT JOHNS FL
32259-1169
US

IV. Provider business mailing address

145 BEACHWALK SHORE DR STE 102 PMB 1031
SAINT JOHNS FL
32259-1169
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-5604
  • Fax:
Mailing address:
  • Phone: 904-325-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: