Provider Demographics
NPI:1659018547
Name:BERNOTIENE, VIRGINIJA AGATHA (APRN)
Entity Type:Individual
Prefix:
First Name:VIRGINIJA
Middle Name:AGATHA
Last Name:BERNOTIENE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3152
Mailing Address - Country:US
Mailing Address - Phone:321-724-9650
Mailing Address - Fax:
Practice Address - Street 1:333 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3152
Practice Address - Country:US
Practice Address - Phone:321-724-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily