Provider Demographics
NPI:1871979138
Name:BERNARD, WENDY
Entity type:Individual
Prefix:MR
First Name:WENDY
Middle Name:
Last Name:BERNARD
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 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:1190 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161
Practice Address - Country:US
Practice Address - Phone:305-891-7500
Practice Address - Fax:305-985-6233
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9276095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4913842OtherAETNA
FLP1035024OtherFREEDOM
FL9050721OtherCIGNA
FLIJ598YOtherMEDICARE (BROWARD COUNTY)
FLP01568202OtherRR MEDICARE
FLP01793250OtherSIMPLY
FLP970844OtherOPTIMUM
FLQMYUDOtherBCBS
FLIJ598ZOtherMEDICARE (DADE COUNTY)