Provider Demographics
NPI:1760810162
Name:BERNDT, TRESA ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRESA
Middle Name:ANN
Last Name:BERNDT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:TRESA
Other - Middle Name:ANN
Other - Last Name:RISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-363-2180
Mailing Address - Fax:330-363-2179
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-2180
Practice Address - Fax:330-363-2179
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15282-NP364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health