MEDICARE: MS. HEATHER MARIE BERTOLERO APRN

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	363L00000X	Nurse Practitioner	RN2359345	MA
2	363L00000X	Nurse Practitioner	APRN9432150	FL
3	363L00000X	Nurse Practitioner	NJ001666	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN9432150	OTHER	FL	APRN
2	NJ001666	OTHER	NJ	NJ LICENSE

General Provider Information

NPI Number	:	1710138268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER MARIE BERTOLERO APRN

Provider Business Mailing Address
First Line	:	4145 BONFIRE DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-4598
Country	:	US
Telephone Number	:	973-464-6033
Fax Number	:

Provider Business Practice Location Address
First Line	:	8745 HENDERSON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1150
Country	:	US
Telephone Number	:	813-922-2526
Fax Number	:	888-768-5029

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	09/19/2025

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