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General NPI Number Information
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NPI Number | 1336928563
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Entity Type | Individual
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Provider Name | HEATHER JUSTINA POOLER DOM, AP, LAC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 111 2ND AVE NE STE 705
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-3441
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Country | US
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Telephone | 727-677-8006
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Fax |
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Provider Business Mailing Address
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Address Line | 146 6TH AVE NE APT 7
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-3022
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Country | US
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Telephone | 813-981-4276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP4085
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License Number State | FL
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