Provider Demographics
NPI:1720410863
Name:BERTLOFF, JOLENE (MLIS, EIPA 36)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:
Last Name:BERTLOFF
Suffix:
Gender:F
Credentials:MLIS, EIPA 36
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-6823
Mailing Address - Country:US
Mailing Address - Phone:813-237-4353
Mailing Address - Fax:813-237-4353
Practice Address - Street 1:1007 E HENRY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-6823
Practice Address - Country:US
Practice Address - Phone:813-237-4353
Practice Address - Fax:813-237-4353
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL171R00000X
OtherINTERPRETER FOR DEAF