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NPI Code Detail

MEDICARE: MS. OCTAVIA N BURGESS APRN

MEDICARE: MS. OCTAVIA N BURGESS APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11031500FL

General Provider Information

NPI Number : 1417714221
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. OCTAVIA N BURGESS APRN
Provider Business Mailing Address
First Line : 5151 ADANSON ST
Second Line :
City : ORLANDO
State : FL
Zip : 32804-1317
Country : US
Telephone Number : 828-390-8255
Fax Number :
Provider Business Practice Location Address
First Line : 1800 MERCY DR
Second Line :
City : ORLANDO
State : FL
Zip : 32808-5646
Country : US
Telephone Number : 407-875-3700
Fax Number : 407-667-1636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2024
Last Update Date : 01/12/2026

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