Provider Demographics
NPI:1710138268
Name:BERTOLERO, HEATHER MARIE (APRN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:BERTOLERO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 BONFIRE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4598
Mailing Address - Country:US
Mailing Address - Phone:973-464-6033
Mailing Address - Fax:
Practice Address - Street 1:8745 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1150
Practice Address - Country:US
Practice Address - Phone:813-922-2526
Practice Address - Fax:888-768-5029
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2359345363L00000X
FLAPRN9432150363L00000X
NJNJ001666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9432150OtherAPRN
NJNJ001666OtherNJ LICENSE