Healthcare Provider Details

I. General information

NPI: 1902182603
Provider Name (Legal Business Name): CHARLES JOSEPH BERNIOL ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 NW 11TH CT
PEMBROKE PINES FL
33024-4709
US

IV. Provider business mailing address

8750 NW 11TH CT
PEMBROKE PINES FL
33024-4709
US

V. Phone/Fax

Practice location:
  • Phone: 954-309-7512
  • Fax:
Mailing address:
  • Phone: 954-309-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2988162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: