Healthcare Provider Details

I. General information

NPI: 1366899825
Provider Name (Legal Business Name): SERENA BURR CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2016
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S NOVA RD STE R
ORMOND BEACH FL
32174-7362
US

IV. Provider business mailing address

800 S NOVA RD STE R
ORMOND BEACH FL
32174-7362
US

V. Phone/Fax

Practice location:
  • Phone: 386-227-7663
  • Fax: 386-204-7117
Mailing address:
  • Phone: 386-227-7663
  • Fax: 386-204-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW329
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: