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General NPI Number Information
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NPI Number | 1528207552
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Entity Type | Individual
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Provider Name | MONIQUE M. BERCES-MARDENLY FNP, MSN, MPH
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Gender | Female
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Dates
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Enumeration Date | 02/14/2009
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 301 DR CARTER BLVD
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City | BUNNELL
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State | FL
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Zip | 32110-6212
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Country | US
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Telephone | 386-437-7350
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Fax | 386-437-7353
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Provider Business Mailing Address
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Address Line | 301 DR CARTER BLVD
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City | BUNNELL
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State | FL
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Zip | 32110-6212
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Country | US
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Telephone | 386-437-7350
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Fax | 386-437-7353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 18296
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11002491
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License Number State | FL
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