Provider Demographics
NPI:1457814634
Name:GERVAIS, BERLYNE (NP-C)
Entity Type:Individual
Prefix:
First Name:BERLYNE
Middle Name:
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6749 CAMELIA DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4846
Mailing Address - Country:US
Mailing Address - Phone:786-586-5114
Mailing Address - Fax:
Practice Address - Street 1:6749 CAMELIA DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4846
Practice Address - Country:US
Practice Address - Phone:786-586-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF03190556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF03190556OtherCERTIFICATION NUMBER