Healthcare Provider Details

I. General information

NPI: 1962775627
Provider Name (Legal Business Name): INAYMIS E BERNAL MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 HOOVER BLVD SUITE 18
TAMPA FL
33634-5330
US

IV. Provider business mailing address

5406 HOOVER BLVD
TAMPA FL
33634-3201
US

V. Phone/Fax

Practice location:
  • Phone: 813-880-7577
  • Fax: 813-880-7553
Mailing address:
  • Phone: 813-880-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: