Individual
AMANDA HEESACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6350 22ND AVE N, ST PETERSBURG, FL 33710-4106
(407) 347-4331
Mailing address
6350 22ND AVE N, ST PETERSBURG, FL 33710-4106
(407) 347-4331
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5264241
FL
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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