Basic Information
| Provider Information | |||||||||
| NPI: | 1871979138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNARD | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056286117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1190 NE 125TH ST | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058917500 | ||||||||
| FaxNumber: | 3059856233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2015 | ||||||||
| LastUpdateDate: | 11/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9276095 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4913842 | 01 | FL | AETNA | OTHER | P1035024 | 01 | FL | FREEDOM | OTHER | 9050721 | 01 | FL | CIGNA | OTHER | IJ598Y | 01 | FL | MEDICARE (BROWARD COUNTY) | OTHER | P01568202 | 01 | FL | RR MEDICARE | OTHER | P01793250 | 01 | FL | SIMPLY | OTHER | P970844 | 01 | FL | OPTIMUM | OTHER | QMYUD | 01 | FL | BCBS | OTHER | IJ598Z | 01 | FL | MEDICARE (DADE COUNTY) | OTHER |