Burgess, Tina Marie

Burgess, Tina Marie is an individual health care provider with primary practice located at 790 Dunlawton Ave Suite E, Port Orange FL 32127-9279. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Burgess, Tina Marie can be contacted via phone (386) 760-1877.

Contact Information

Primary practice address
790 Dunlawton Ave Suite E Port Orange FL 32127-9279
Phone: (386) 760-1877
Fax: (386) 760-2791
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ARNP1840402 Florida

Profile Details

NPI number 1962503045
LBN Legal business name Burgess, Tina Marie
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2006
Last updated Apr 5th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962503045 NPPES
Florida Other 45360 MEDICARE GROUP
Florida Other 59-3667262 MEDICARE GROUP

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