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Individual

ALETA ST. JACQUES BERNSTEIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
8002 GUNN HWY, TAMPA, FL 33626-1603
(813) 886-7673
(813) 792-7895
Mailing address
4715 GRAINARY AVE, TAMPA, FL 33624-2105

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107867
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA9107867
MEDICAL LICENSE
FL
01
PAX00001771
PRESCRIBING LICENSE
FL
Enumeration date
05/24/2007
Last updated
03/29/2016
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