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Individual
MAURA HERTZOG
Active
Individual
MAURA HERTZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2015
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00450773
MEDICARE RAIL ROAD
FL
01
—
PA2015
LICENSE
FL
Enumeration date
12/05/2006
Last updated
12/30/2016
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