Provider Demographics
NPI:1265238901
Name:BERGIN, LISA MICHELLE (FNLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:BERGIN
Suffix:
Gender:
Credentials:FNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 RIVERTRACE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7778
Mailing Address - Country:US
Mailing Address - Phone:301-633-2000
Mailing Address - Fax:
Practice Address - Street 1:1555 RIVERTRACE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-7778
Practice Address - Country:US
Practice Address - Phone:301-633-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach