Provider Demographics
NPI:1619585288
Name:VEGA BERRIOS, MADELINE (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:VEGA BERRIOS
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 E IRLO BRONSON MEMORIAL HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-5836
Mailing Address - Country:US
Mailing Address - Phone:407-583-4795
Mailing Address - Fax:407-583-6412
Practice Address - Street 1:1714 E IRLO BRONSON MEMORIAL HWY STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-5836
Practice Address - Country:US
Practice Address - Phone:407-583-4795
Practice Address - Fax:407-583-6412
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390051163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator