Provider Demographics
NPI:1508887506
Name:ERMINE, PAMELA MARNI (DO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARNI
Last Name:ERMINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 ENTERPRISE CTR STE 102
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3760
Mailing Address - Country:US
Mailing Address - Phone:561-536-7884
Mailing Address - Fax:561-336-3776
Practice Address - Street 1:10151 ENTERPRISE CTR STE 102
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3760
Practice Address - Country:US
Practice Address - Phone:561-536-7884
Practice Address - Fax:561-336-3776
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I63316Medicare UPIN
FLU8333Medicare PIN