Provider Demographics
NPI:1659846467
Name:BERGMAN, ARIELLE NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:NICOLE
Last Name:BERGMAN
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 1:12146 BEAR RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4970
Mailing Address - Country:US
Mailing Address - Phone:954-803-0166
Mailing Address - Fax:
Practice Address - Street 1:21301 POWERLINE RD UNIT 108
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2388
Practice Address - Country:US
Practice Address - Phone:561-757-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9371849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner