Provider Demographics
NPI:1073363719
Name:LOUISIUS, BERLYNE
Entity Type:Individual
Prefix:
First Name:BERLYNE
Middle Name:
Last Name:LOUISIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD STE 3102
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7189
Mailing Address - Country:US
Mailing Address - Phone:561-406-6561
Mailing Address - Fax:
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 3102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7189
Practice Address - Country:US
Practice Address - Phone:561-635-5690
Practice Address - Fax:561-406-6629
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031629363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health