Healthcare Provider Details

I. General information

NPI: 1114275021
Provider Name (Legal Business Name): JENNIFER MARIE BERGER-VERNACE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE BERGER DO

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LYCKMAN DRIVE
FOUNTAIN CO
80817-2861
US

IV. Provider business mailing address

285 SE 5TH AVE
DELRAY BEACH FL
33483-5206
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-322-0776
Mailing address:
  • Phone: 561-272-8991
  • Fax: 561-272-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS13413
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR0072297
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A12405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: