Healthcare Provider Details

I. General information

NPI: 1801581988
Provider Name (Legal Business Name): HEATHER BRINKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PASEO REYES DR
ST AUGUSTINE FL
32095-8462
US

IV. Provider business mailing address

211 TARPON BAY CT
PONTE VEDRA FL
32081-1501
US

V. Phone/Fax

Practice location:
  • Phone: 904-710-2092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: