MEDICARE: MS. JOAN W BERNSTEIN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1064714	FL

General Provider Information

NPI Number	:	1114982113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN W BERNSTEIN PA

Provider Business Mailing Address
First Line	:	12050 PARK BLVD #238
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772
Country	:	US
Telephone Number	:	727-391-0704
Fax Number	:

Provider Business Practice Location Address
First Line	:	4880 - 49TH STREET NORTH
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33709
Country	:	US
Telephone Number	:	727-526-9019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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