Healthcare Provider Details

I. General information

NPI: 1588998447
Provider Name (Legal Business Name): CHOOSAK DANNY BURR NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

326 N MILLS AVE
ORLANDO FL
32803-5734
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-0148
  • Fax:
Mailing address:
  • Phone: 407-841-1100
  • Fax: 407-650-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016021A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79550
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 9190765
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02226
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: