Provider Demographics
NPI:1528207552
Name:BERCES-MARDENLY, MONIQUE M (FNP, MSN, MPH)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:M
Last Name:BERCES-MARDENLY
Suffix:
Gender:F
Credentials:FNP, MSN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DR CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-6212
Mailing Address - Country:US
Mailing Address - Phone:386-437-7350
Mailing Address - Fax:386-437-7353
Practice Address - Street 1:301 DR CARTER BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-6212
Practice Address - Country:US
Practice Address - Phone:386-437-7350
Practice Address - Fax:386-437-7353
Is Sole Proprietor?:No
Enumeration Date:2009-02-14
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18296363LF0000X
FLAPRN11002491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0276496OtherL AND I
WA1528207552Medicaid
WAP01169704OtherRAILROAD MEDICARE
WA1528207552Medicaid