Provider Demographics
NPI:1124572011
Name:VERNILLO, HEATHER AYNNE (APRN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:AYNNE
Last Name:VERNILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 ALT 19 SUITE B4
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1929
Mailing Address - Country:US
Mailing Address - Phone:727-342-0155
Mailing Address - Fax:888-561-5898
Practice Address - Street 1:3060 ALT 19 SUITE B4
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1929
Practice Address - Country:US
Practice Address - Phone:727-342-0155
Practice Address - Fax:888-561-5898
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9330256363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty