Provider Demographics
NPI:1194231522
Name:BERMUDEZ, OSVANY (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:OSVANY
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 N UNIVERSITY DR STE 206
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2953
Mailing Address - Country:US
Mailing Address - Phone:954-724-7410
Mailing Address - Fax:954-724-7412
Practice Address - Street 1:7421 N UNIVERSITY DR STE 206
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2953
Practice Address - Country:US
Practice Address - Phone:954-724-7410
Practice Address - Fax:954-724-7412
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical