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General NPI Number Information
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NPI Number | 1538832035
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Entity Type | Organization
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Legal Business Name | BERG PRIMARY CARE & HOUSE CALLS LLC
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 211 LIVE OAK LN
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City | LARGO
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State | FL
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Zip | 33770-4074
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Country | US
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Telephone | 727-233-1951
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Fax | 727-313-9841
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Provider Business Mailing Address
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Address Line | PO BOX 782
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City | LARGO
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State | FL
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Zip | 33779-0782
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Country | US
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Telephone | 727-233-1951
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Fax | 727-313-9841
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDRIA MILLS BERG
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Credential | APRN
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Telephone | 727-233-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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