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
State | License ID | Taxonomies |
---|---|---|
FL | ARNP 3276542 | 363LP0808X |
PA | RN249960L | 163W00000X, 163WG0000X, 163WH0200X, 163WH1000X, 163WP0807X, 163WA0400X |
PA | ANCC 0270519-01 | 364SP0808X, 163WC1600X, 163WC0400X |
GA | RN193789 CNS/PMH | 364SP0808X |
PA | ANCC 0270519-01 | 101YM0800X |
ANCC 0270519-01 | 171000000X, 171W00000X, 374T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health |
No | 163WC1600X | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development |
No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice |
No | 163WC0400X | Nursing Service Providers | Registered Nurse | Case Management |
No | 163WH1000X | Nursing Service Providers | Registered Nurse | Hospice |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent |
No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 171000000X | Other Service Providers | Military Health Care Provider | |
No | 171W00000X | Other Service Providers | Contractor | |
No | 374T00000X | Nursing Service Related Providers | Religious Nonmedical Nursing Personnel |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
11697378 | Other | CAQH, AARP UNITED HEALTH CARE INSURANCE | |
PA | 103583336 | Other | UNITED BEHAVIORAL HEALTH |
11697378 | Other | CAQH, AARP UNITED HEALTH CARE INSURANCE | |
FL | 000K0333 | Medicare UPIN |