Provider Demographics
NPI:1285277780
Name:BERDELLANS, CATHERINE (PA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BERDELLANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 SW 54TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5521
Mailing Address - Country:US
Mailing Address - Phone:352-857-8417
Mailing Address - Fax:855-428-0627
Practice Address - Street 1:6041 SW 54TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5521
Practice Address - Country:US
Practice Address - Phone:352-857-8417
Practice Address - Fax:855-428-0627
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant