MEDICARE: ISAAC BURDEINICK APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	ABSA 12-191	FL
2	163W00000X	Registered Nurse	RN9544171	FL
3	363L00000X	Nurse Practitioner	APRN11020794	FL

General Provider Information

NPI Number	:	1063754455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC BURDEINICK APRN

Provider Business Mailing Address
First Line	:	4850 W OAKLAND PARK BLVD STE 201
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-7268
Country	:	US
Telephone Number	:	954-735-3535
Fax Number	:	954-484-7000

Provider Business Practice Location Address
First Line	:	4850 W OAKLAND PARK BLVD STE 201
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-7268
Country	:	US
Telephone Number	:	954-735-3535
Fax Number	:	954-484-7000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2013
Last Update Date	:	01/30/2023

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