| Doctor Name: | MS. JACKIE BURGESS |
| NPI Number: | 1326415951 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M. |
| License Number: | MW304 |
| Business Practice Address: | 20230 Estero Gardens Cir Unit 206 Estero, FL - 339283457 |
| Business Phone Number: | 2396998718 |
| Business Fax Number: | 2393021352 |
| Mailing Address: | 20230 Estero Gardens Cir, Unit 206 ESTERO |
| State: | FL |
| Postal Code: | 339283457 |
| Phone Number: | 2396998718 |
| Fax Number: | 2393021352 |
| NPI Enumeration Date: | 08/31/2015 |
| NPI Last Update Date: | 08/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0000X |
| License Number: | MW304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Obstetrics |
| Taxonomy Definition: | |