Provider Demographics
NPI:1568748176
Name:MERTZ, BRITTANY N (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:MERTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:N
Other - Last Name:BERGAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:9680 ARGYLE FOREST BLVD STE 34
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2847
Mailing Address - Country:US
Mailing Address - Phone:045-697-7719
Mailing Address - Fax:
Practice Address - Street 1:9680 ARGYLE FOREST BLVD STE 34
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2847
Practice Address - Country:US
Practice Address - Phone:045-697-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA06377363A00000X
FLPA9108086363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016363900Medicaid
FLP01564598OtherRR MCR
FL016363900Medicaid