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General NPI Number Information
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NPI Number | 1790143139
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Entity Type | Individual
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Provider Name | JEANICE BURKE CRNA, MSN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2016
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2165 HERSCHEL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3819
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Country | US
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Telephone | 904-603-0848
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Fax |
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Provider Business Mailing Address
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Address Line | 4303 RICHMOND PARK DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32224-1284
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Country | US
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Telephone |
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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 | CRNA1217
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP 9312264
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License Number State | FL
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