Healthcare Provider Details

I. General information

NPI: 1114830478
Provider Name (Legal Business Name): DAVITA BURNEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 W DR MARTIN LUTHER KING JR BLVD
SEFFNER FL
33584-4534
US

IV. Provider business mailing address

704 W DR MARTIN LUTHER KING JR BLVD
SEFFNER FL
33584-4534
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-4431
  • Fax: 813-653-9926
Mailing address:
  • Phone: 813-681-4431
  • Fax: 813-653-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: