Provider Demographics
NPI:1437821279
Name:DUPERVIL, BERTHE CLAUDIA (APRN)
Entity Type:Individual
Prefix:
First Name:BERTHE
Middle Name:CLAUDIA
Last Name:DUPERVIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BERTHE CLAUDIA
Other - Middle Name:CLAUDIA
Other - Last Name:CASSEUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:1720 S GADSDEN ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5506
Mailing Address - Country:US
Mailing Address - Phone:850-576-4073
Mailing Address - Fax:850-576-6849
Practice Address - Street 1:1720 S GADSDEN ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5506
Practice Address - Country:US
Practice Address - Phone:850-576-4073
Practice Address - Fax:850-576-6849
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015681208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty