MEDICARE: RENAE BERGERON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024196466	VA

General Provider Information

NPI Number	:	1215810932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE BERGERON

Provider Business Mailing Address
First Line	:	1205 BARTLETT OAKS CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-6853
Country	:	US
Telephone Number	:	985-474-0181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 BARTLETT OAKS CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-6853
Country	:	US
Telephone Number	:	985-474-0181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	03/24/2026

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Directions to “ RENAE BERGERON ” Practice Location

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