Healthcare Provider Details

I. General information

NPI: 1467370601
Provider Name (Legal Business Name): SHAYLEE JANELLE HEISTAD CPNP, DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH AVE S STE 450
ST PETERSBURG FL
33701-4629
US

IV. Provider business mailing address

5020 CEDAR LEAF CIR UNIT 95
PALMETTO FL
34221-1336
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11048185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: