Provider Demographics
NPI:1588875454
Name:BERNSTEIN, ALETA ST JACQUES (PA)
Entity type:Individual
Prefix:
First Name:ALETA
Middle Name:ST JACQUES
Last Name:BERNSTEIN
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 1:4715 GRAINARY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8002 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1603
Practice Address - Country:US
Practice Address - Phone:813-886-7673
Practice Address - Fax:813-792-7895
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9107867OtherMEDICAL LICENSE
FLPAX00001771OtherPRESCRIBING LICENSE
FLS65617Medicare UPIN