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General NPI Number Information
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NPI Number | 1902400153
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Entity Type | Individual
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Provider Name | JACQUELINE BERKOVSKY PA
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Gender | Female
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 9868 S STATE ROAD 7 STE 330
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-4477
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Country | US
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Telephone | 561-880-8866
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Fax |
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Provider Business Mailing Address
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Address Line | 9205 MOUNTAIN PINE GRV
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City | BOYNTON BEACH
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State | FL
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Zip | 33473-7405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9117616
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License Number State | FL
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