Healthcare Provider Details

I. General information

NPI: 1144739137
Provider Name (Legal Business Name): LESLI BURDICK CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLI BURDICK CAA

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number22355902
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: