Individual
BERTHA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15420 LIVINGSTON AVE APT 1205, LUTZ, FL 33559-3419
(702) 606-4701
Mailing address
15420 LIVINGSTON AVE APT 1205, LUTZ, FL 33559-3419
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9375645
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
623168900
DEPARTMENT OF LABOR
—
Enumeration date
02/27/2017
Last updated
02/27/2017
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