Individual
LAURA KATHERINE BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1222 S ORANGE AVE, ORLANDO, FL 32806-1215
(407) 423-7777
(407) 423-1380
Mailing address
60 COLUMBIA ST, ORLANDO, FL 32806-1115
(407) 423-7777
(407) 423-1380
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9111160
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9111160
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024256600
—
FL
Enumeration date
03/10/2018
Last updated
09/13/2024
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