Provider Demographics
NPI:1154482032
Name:ERKERT, JERRY DENNIS (PHD, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:DENNIS
Last Name:ERKERT
Suffix:
Gender:M
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 TREASURE COVE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2866
Mailing Address - Country:US
Mailing Address - Phone:904-223-4314
Mailing Address - Fax:
Practice Address - Street 1:1895 KINGSLEY AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4466
Practice Address - Country:US
Practice Address - Phone:904-213-2600
Practice Address - Fax:904-213-2566
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 1833363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical