Healthcare Provider Details

I. General information

NPI: 1053285395
Provider Name (Legal Business Name): DAMARIS NOVOTE BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 10/24/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 GOLDEN GATE PKWY
NAPLES FL
34116-7524
US

IV. Provider business mailing address

1725 GOLDEN GATE BLVD E
NAPLES FL
34120-3606
US

V. Phone/Fax

Practice location:
  • Phone: 239-778-8455
  • Fax: 239-977-3644
Mailing address:
  • Phone: 239-778-8455
  • Fax: 239-977-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: