Healthcare Provider Details

I. General information

NPI: 1952056194
Provider Name (Legal Business Name): MAUREEN BERNING LM, CMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LITHIA PINECREAST RD
BRANDON FL
33511
US

IV. Provider business mailing address

4502 W PAXTON AVE
TAMPA FL
33611-5616
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-8404
  • Fax:
Mailing address:
  • Phone: 813-468-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: