Healthcare Provider Details

I. General information

NPI: 1295324937
Provider Name (Legal Business Name): MADELINE DOROTHY BERTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3378 MARINER BLVD
SPRING HILL FL
34609-2460
US

IV. Provider business mailing address

3378 MARINER BLVD
SPRING HILL FL
34609-2460
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-7171
  • Fax: 352-556-4889
Mailing address:
  • Phone: 352-796-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: