Provider Demographics
NPI:1154318558
Name:BERARDI, PHILIP FRANCIS (PA C)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:FRANCIS
Last Name:BERARDI
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-6200
Mailing Address - Country:US
Mailing Address - Phone:352-671-4300
Mailing Address - Fax:352-671-4393
Practice Address - Street 1:1818 SW 15TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3548
Practice Address - Country:US
Practice Address - Phone:352-671-4300
Practice Address - Fax:352-671-4393
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290563900Medicaid
FL290563900Medicaid
FLE1772YMedicare ID - Type Unspecified