Provider Demographics
NPI:1164620845
Name:YERGEN, CARA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:MARIE
Last Name:YERGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CARA
Other - Middle Name:MARIE
Other - Last Name:RUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 37TH PL STE 2
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6502
Mailing Address - Country:US
Mailing Address - Phone:772-794-0179
Mailing Address - Fax:
Practice Address - Street 1:840 37TH PL STE 2
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6502
Practice Address - Country:US
Practice Address - Phone:772-794-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2729652084P0800X
CA1502712084P0800X
PAMD4614802084P0800X
FLME1009522084P0800X
CT0460702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000996000Medicaid
FL145TJOtherBCBS OF FL
FL107990200Medicaid
FLCF513YMedicare PIN