Healthcare Provider Details

I. General information

NPI: 1245296854
Provider Name (Legal Business Name): CHERYL ANN BURNS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 NW 39TH ST
GAINESVILLE FL
32605-4719
US

IV. Provider business mailing address

PO BOX 140777
GAINESVILLE FL
32614-0777
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-0019
  • Fax:
Mailing address:
  • Phone: 352-373-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0035750
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301041557
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: