MEDICARE: DR. BONNIE ANN HEIDEL-ARNOLD DOM; L.AC; LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	AP 1947	FL
2	172M00000X	Mechanotherapist	MA 12560	FL
3	173C00000X	Reflexologist	MA 12560	FL
4	175L00000X	Homeopath	AP 1947	FL
5	171100000X	Acupuncturist	AP 1947	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12568072	OTHER	FL	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356534416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE ANN HEIDEL-ARNOLD DOM; L.AC; LMT

Provider Business Mailing Address
First Line	:	15350 AMBERLY DRIVE
Second Line	:	3611
City	:	TAMPA
State	:	FL
Zip	:	33647-1636
Country	:	US
Telephone Number	:	239-775-0212
Fax Number	:	813-435-3002

Provider Business Practice Location Address
First Line	:	15350 AMBERLY DR UNIT 3611
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647
Country	:	US
Telephone Number	:	239-775-0212
Fax Number	:	813-435-3002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	07/06/2018

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