Healthcare Provider Details

I. General information

NPI: 1093510158
Provider Name (Legal Business Name): BURD MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WINGED ELM CT
ST AUGUSTINE FL
32092-3547
US

IV. Provider business mailing address

52 TUSCAN WAY STE 202 - 353
ST. AUGUSTINE FL
32092
US

V. Phone/Fax

Practice location:
  • Phone: 904-902-1234
  • Fax:
Mailing address:
  • Phone: 904-902-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY BURD
Title or Position: OWNER
Credential: PMHNP
Phone: 904-902-1234