Provider Demographics
NPI:1376079137
Name:BERGIN, ERIN DANIELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DANIELLE
Last Name:BERGIN
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 1:8188 S JOG RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2952
Mailing Address - Country:US
Mailing Address - Phone:561-229-1099
Mailing Address - Fax:561-557-5600
Practice Address - Street 1:8188 S JOG RD STE 205
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2952
Practice Address - Country:US
Practice Address - Phone:561-229-1099
Practice Address - Fax:561-557-5600
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9338201163W00000X
FLARNP9338201363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14388578OtherCAQH ID NUMBER
FLRN9338201OtherREGISTERED NURSE, CERTIFIED
FLARNP9338201OtherARNP MEDICAL LICENSE