Provider Demographics
NPI:1952474033
Name:SUGERMAN, BERTHA DOLLY (ARNP)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:DOLLY
Last Name:SUGERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:DOLLY
Other - Last Name:SERNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9020 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3234
Mailing Address - Country:US
Mailing Address - Phone:602-889-9401
Mailing Address - Fax:602-889-9404
Practice Address - Street 1:1585 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2924
Practice Address - Country:US
Practice Address - Phone:305-512-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3382742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ068651Medicaid