Provider Demographics
NPI:1083650147
Name:CARDELLE, BERTHA PUENTE (APRN)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:PUENTE
Last Name:CARDELLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 SW 143RD ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7580
Mailing Address - Country:US
Mailing Address - Phone:786-306-5039
Mailing Address - Fax:
Practice Address - Street 1:7700 N KENDALL DR STE 610
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7567
Practice Address - Country:US
Practice Address - Phone:305-639-8160
Practice Address - Fax:305-647-2849
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL972472363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083650147Medicaid
FL307411100Medicaid