Individual
TERESA BERNARD I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
414 OLD HARD RD STE 104, ORANGE PARK, FL 32003-3406
(904) 269-6400
(904) 269-6410
Mailing address
414 OLD HARD RD STE 104, ORANGE PARK, FL 32003-3406
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME46372
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6957412
CIGNA INSURANCE
FL
Enumeration date
02/08/2007
Last updated
07/09/2007
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