Healthcare Provider Details

I. General information

NPI: 1255046165
Provider Name (Legal Business Name): JESSICA M BURES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

IV. Provider business mailing address

655 MOHEGAN CIR
CANTONMENT FL
32533-5634
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-2155
  • Fax:
Mailing address:
  • Phone: 334-803-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: