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General NPI Number Information
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NPI Number | 1285442657
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Entity Type | Individual
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Provider Name | RUSSELL LEE BURNEY
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Gender | Male
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 2001 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5148
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Country | US
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Telephone | 904-639-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 2498 SANDRIDGE RD
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8602
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Country | US
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Telephone | 904-838-8953
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 11037366
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License Number State | FL
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