Healthcare Provider Details

I. General information

NPI: 1497086383
Provider Name (Legal Business Name): BERNADETTE DIANA THOMPSON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2010
Last Update Date: 01/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SAN MARINO RD SW
PALM BAY FL
32908-3332
US

IV. Provider business mailing address

279 SAN MARINO RD SW
PALM BAY FL
32908-3332
US

V. Phone/Fax

Practice location:
  • Phone: 321-720-2790
  • Fax:
Mailing address:
  • Phone: 321-720-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT1940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: