Provider Demographics
NPI:1598258774
Name:BERGMANN PANETTA, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BERGMANN PANETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 DOUGLAS AVE STE 1855
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2588
Mailing Address - Country:US
Mailing Address - Phone:407-212-1199
Mailing Address - Fax:
Practice Address - Street 1:455 DOUGLAS AVE STE 1855
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-2588
Practice Address - Country:US
Practice Address - Phone:407-212-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician