Provider Demographics
NPI:1588094379
Name:BUCKLEY, BERNADETTE (PHD, ATC)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNF DRIVE
Mailing Address - Street 2:BROOKS COLLEGE OF HEALTH, CAMS
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:904-620-1419
Mailing Address - Fax:904-620-2848
Practice Address - Street 1:1 UNF DRIVE
Practice Address - Street 2:BROOKS COLLEGE OF HEALTH, CAMS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-620-1419
Practice Address - Fax:904-620-2848
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 21762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer