Provider Demographics
NPI:1144817594
Name:BERGER, ANTONELLA M (ARNP)
Entity type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:M
Last Name:BERGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 SEA CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1146
Mailing Address - Country:US
Mailing Address - Phone:914-255-2880
Mailing Address - Fax:
Practice Address - Street 1:8837 SEA CHASE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1146
Practice Address - Country:US
Practice Address - Phone:914-255-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12201043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine