Doctor Name: | MRS. LAURA JEANNE BURGESS |
NPI Number: | 1831573096 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, FNP-BC |
License Number: | 3414042 |
Business Practice Address: | 775 Malabar Rd Malabar, FL - 329503120 |
Business Phone Number: | 3217229005 |
Business Fax Number: | |
Mailing Address: | 775 Malabar Rd, MALABAR |
State: | FL |
Postal Code: | 32950 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/16/2015 |
NPI Last Update Date: | 07/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3414042 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |