Provider Demographics
NPI:1558171835
Name:BERGMAN, SIMONE KRISTEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:KRISTEN
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:KRISTEN
Other - Last Name:HAVILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8703 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4622
Mailing Address - Country:US
Mailing Address - Phone:410-301-3572
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:667-214-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR244207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily