Provider Demographics
NPI:1003079922
Name:BERARDINELLI, GINA LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LYNN
Last Name:BERARDINELLI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 W MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4510
Mailing Address - Country:US
Mailing Address - Phone:440-266-5500
Mailing Address - Fax:440-266-5505
Practice Address - Street 1:9485 MENTOR AVE STE 102
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8722
Practice Address - Country:US
Practice Address - Phone:440-266-5500
Practice Address - Fax:440-266-5505
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP10067363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2851570Medicaid
OHFINP28031Medicare PIN