Provider Demographics
NPI:1114275021
Name:BERGER-VERNACE, JENNIFER MARIE (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:BERGER-VERNACE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:285 SE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5206
Mailing Address - Country:US
Mailing Address - Phone:561-272-8991
Mailing Address - Fax:561-272-8985
Practice Address - Street 1:350 LYCKMAN DRIVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2861
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-322-0776
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13413208000000X
CODR0072297208000000X
CA20A12405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12405OtherDO LICENSE
CAOS13413OtherDO LICENSE