Provider Demographics
NPI:1740544568
Name:BERNSTEIN, NINA PHILLIPS (DO)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:PHILLIPS
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:ELISA
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-389-7000
Mailing Address - Fax:954-389-8726
Practice Address - Street 1:1835 N CORPORATE LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-389-7000
Practice Address - Fax:954-389-8726
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13838208000000X, 208M00000X, 208M00000X
FLUO2729390200000X
CT52785390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017207200Medicaid