Healthcare Provider Details

I. General information

NPI: 1780785626
Provider Name (Legal Business Name): JOLENE MARIE BURLEY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOLENE MARIE BORRELLI RRT

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

25740S.W 19TH AVE.
NEWBERRY FL
32669-5026
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 352-472-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: