Provider Demographics
NPI:1285807073
Name:MONTILLA, BERNARDITA P (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:BERNARDITA
Middle Name:P
Last Name:MONTILLA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 WHITEWAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3461
Mailing Address - Country:US
Mailing Address - Phone:813-988-5133
Mailing Address - Fax:
Practice Address - Street 1:4922 WHITEWAY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3461
Practice Address - Country:US
Practice Address - Phone:813-988-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL693094896/693094898385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child