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General NPI Number Information
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NPI Number | 1679076285
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Entity Type | Individual
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Provider Name | LAURA KATHERINE BERG PA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2018
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 1222 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-1215
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Country | US
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Telephone | 407-423-7777
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Fax | 407-423-1380
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Provider Business Mailing Address
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Address Line | 60 COLUMBIA ST
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City | ORLANDO
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State | FL
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Zip | 32806-1115
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Country | US
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Telephone | 407-423-7777
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Fax | 407-423-1380
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9111160
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9111160
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License Number State | FL
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