Healthcare Provider Details

I. General information

NPI: 1407247646
Provider Name (Legal Business Name): BERK YILMAZ A.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 DEERFIELD LN
CLEARWATER FL
33761-1408
US

IV. Provider business mailing address

3426 DEERFIELD LN
CLEARWATER FL
33761-1408
US

V. Phone/Fax

Practice location:
  • Phone: 727-543-5391
  • Fax:
Mailing address:
  • Phone: 727-543-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA 255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: