Healthcare Provider Details

I. General information

NPI: 1871439612
Provider Name (Legal Business Name): NOLA BURGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87009 PROFESSIONAL WAY
YULEE FL
32097-3400
US

IV. Provider business mailing address

13404 LANIER RD
JACKSONVILLE FL
32226-1787
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 904-626-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: