Provider Demographics
NPI:1235895194
Name:BERGERON, AUSTIN CHARLES (PA-C)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CHARLES
Last Name:BERGERON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 NE 9TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3590
Mailing Address - Country:US
Mailing Address - Phone:954-563-4500
Mailing Address - Fax:
Practice Address - Street 1:2320 NE 9TH ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3590
Practice Address - Country:US
Practice Address - Phone:954-563-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115307208200000X, 363AS0400X
RIPA01644363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant