Provider Demographics
NPI:1497709190
Name:BERES, JANET LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LYNN
Last Name:BERES
Suffix:
Gender:F
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 1:7575 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7216
Mailing Address - Country:US
Mailing Address - Phone:407-352-8553
Mailing Address - Fax:407-351-8412
Practice Address - Street 1:7575 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7216
Practice Address - Country:US
Practice Address - Phone:407-352-8553
Practice Address - Fax:407-351-8412
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS68732Medicare UPIN
FLE1735WMedicare ID - Type UnspecifiedMEDICARE #