Provider Demographics
NPI:1699431981
Name:NAU, BERNARD (SA-C)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:NAU
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:J
Other - Last Name:NAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 NW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3423
Mailing Address - Country:US
Mailing Address - Phone:954-336-8474
Mailing Address - Fax:
Practice Address - Street 1:2101 NW 111TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3423
Practice Address - Country:US
Practice Address - Phone:195-433-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-593246ZC0007X
FLRN9633080163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty