Provider Demographics
NPI:1760844724
Name:COX, BERNETTA
Entity Type:Individual
Prefix:
First Name:BERNETTA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 SAND PEBBLE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-8694
Mailing Address - Country:US
Mailing Address - Phone:407-765-8403
Mailing Address - Fax:
Practice Address - Street 1:12120 SAND PEBBLE WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-8694
Practice Address - Country:US
Practice Address - Phone:407-765-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management