Provider Demographics
NPI:1093509788
Name:BERTAGNA, NATALIA WINTER
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:WINTER
Last Name:BERTAGNA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-9114
Mailing Address - Country:US
Mailing Address - Phone:321-615-5532
Mailing Address - Fax:
Practice Address - Street 1:5914 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-9114
Practice Address - Country:US
Practice Address - Phone:321-615-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1177437106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician