Healthcare Provider Details

I. General information

NPI: 1962953349
Provider Name (Legal Business Name): ERIC N. BERTHA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

9506 NW 38TH ST
CORAL SPRINGS FL
33065-1607
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-5000
  • Fax:
Mailing address:
  • Phone: 610-506-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9109880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: