Healthcare Provider Details

I. General information

NPI: 1922287549
Provider Name (Legal Business Name): PATRICIA R BURT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 W GRANADA BLVD STE 2B
ORMOND BEACH FL
32174-1818
US

IV. Provider business mailing address

1688 W GRANADA BLVD STE 2B
ORMOND BEACH FL
32174-1818
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-3530
  • Fax: 386-673-1933
Mailing address:
  • Phone: 386-677-3530
  • Fax: 386-673-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberARNP814492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: