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General NPI Number Information
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NPI Number | 1124742168
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Entity Type | Individual
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Provider Name | DAISHA BURGESS APRN
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3065
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Country | US
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Telephone | 863-680-7190
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Fax | 866-264-8519
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Provider Business Mailing Address
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Address Line | 3141 WINCHESTER ESTATES LOOP
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City | LAKELAND
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State | FL
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Zip | 33810-4367
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Country | US
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Telephone | 863-398-8376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP11022343
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN11022343
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License Number State | FL
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