Provider Demographics
NPI:1780924258
Name:BERNARD, SAMUEL TERRELL (CSFA)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:TERRELL
Last Name:BERNARD
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2814
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-2814
Mailing Address - Country:US
Mailing Address - Phone:727-417-0355
Mailing Address - Fax:
Practice Address - Street 1:7048 69TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3930
Practice Address - Country:US
Practice Address - Phone:727-417-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
139299246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant