Provider Demographics
NPI:1093807802
Name:BERNIER FAMILY PRACTICE AND ASSOCIATES
Entity Type:Organization
Organization Name:BERNIER FAMILY PRACTICE AND ASSOCIATES
Other - Org Name:EMERALD MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARACELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-248-7925
Mailing Address - Street 1:P.O. BOX 2052
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444
Mailing Address - Country:US
Mailing Address - Phone:850-248-7925
Mailing Address - Fax:850-248-7928
Practice Address - Street 1:1606 TENNESSEE AVE.
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444
Practice Address - Country:US
Practice Address - Phone:850-248-7925
Practice Address - Fax:850-248-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49130OtherBCBS FLORIDA
FL106634000Medicaid
FL106634000Medicaid
FLH00526Medicare UPIN