Provider Demographics
NPI:1376600437
Name:BERESKIE, TONI ANN (APRN,BC,MSN,MBA,CS)
Entity Type:Individual
Prefix:MRS
First Name:TONI ANN
Middle Name:
Last Name:BERESKIE
Suffix:
Gender:F
Credentials:APRN,BC,MSN,MBA,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 GERMANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-9050
Mailing Address - Country:US
Mailing Address - Phone:570-875-7858
Mailing Address - Fax:570-875-2250
Practice Address - Street 1:1220 WILLIS AVE
Practice Address - Street 2:BOX 67
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2810
Practice Address - Country:US
Practice Address - Phone:570-875-7858
Practice Address - Fax:570-875-2250
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3276542363LP0808X
PARN249960L163W00000X, 163WG0000X, 163WH0200X, 163WH1000X, 163WP0807X, 163WA0400X
PAANCC 0270519-01364SP0808X, 163WC1600X, 163WC0400X
GARN193789 CNS/PMH364SP0808X
PAANCC 0270519-01101YM0800X
ANCC 0270519-01171000000X, 171W00000X, 374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171000000XOther Service ProvidersMilitary Health Care Provider
No171W00000XOther Service ProvidersContractor
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
11697378OtherCAQH, AARP UNITED HEALTH CARE INSURANCE
PA103583336OtherUNITED BEHAVIORAL HEALTH
11697378OtherCAQH, AARP UNITED HEALTH CARE INSURANCE
FL000K0333Medicare UPIN