Provider Demographics
NPI:1942065032
Name:BERNETT, ANDREW SCOTT
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:SCOTT
Last Name:BERNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TALAQUAH BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3701
Mailing Address - Country:US
Mailing Address - Phone:724-288-5431
Mailing Address - Fax:
Practice Address - Street 1:1360 N US HIGHWAY 1 STE 106
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8901
Practice Address - Country:US
Practice Address - Phone:386-898-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist