Provider Demographics
NPI:1275327124
Name:ANDERSON, BERNADETTE CATHERINE
Entity type:Individual
Prefix:MISS
First Name:BERNADETTE
Middle Name:CATHERINE
Last Name:ANDERSON
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 1:3219 WHEELING CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8046
Mailing Address - Country:US
Mailing Address - Phone:727-992-2384
Mailing Address - Fax:
Practice Address - Street 1:3219 WHEELING CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8046
Practice Address - Country:US
Practice Address - Phone:727-992-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA-3496031171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach