Provider Demographics
NPI:1427776269
Name:BERKABILE, JONATHAN (APRN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BERKABILE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10556 MOUNT BLACKBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5051
Mailing Address - Country:US
Mailing Address - Phone:702-349-6395
Mailing Address - Fax:
Practice Address - Street 1:500 N RAINBOW BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1084
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV858600207PE0004X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services