Healthcare Provider Details

I. General information

NPI: 1164352761
Provider Name (Legal Business Name): NAOMI BERGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 FLORIDA AVE S
ROCKLEDGE FL
32955-2423
US

IV. Provider business mailing address

PO BOX 236731
COCOA FL
32923-6731
US

V. Phone/Fax

Practice location:
  • Phone: 321-917-8785
  • Fax:
Mailing address:
  • Phone: 321-917-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA38000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: