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Individual

KELLY BERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1000 WATERMAN WAY, TAVARES, FL 32778-5266
(352) 253-3333
Mailing address
1000 WATERMAN WAY, TAVARES, FL 32778-5266

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
PA9114955
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9114955
FL

Other

Enumeration date
04/11/2022
Last updated
04/18/2023
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