Provider Demographics
NPI:1114982113
Name:BERNSTEIN, JOAN W (PA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:W
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 PARK BLVD #238
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772
Mailing Address - Country:US
Mailing Address - Phone:727-391-0704
Mailing Address - Fax:
Practice Address - Street 1:4880 - 49TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-526-9019
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1064714363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical