MEDICARE: TARANEISHA RYSHAN BURGESS NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	APRN9313658	FL

General Provider Information

NPI Number	:	1316397912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARANEISHA RYSHAN BURGESS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2247 PALM BEACH LAKES BLVD STE 206
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3413
Country	:	US
Telephone Number	:	561-841-6960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2247 PALM BEACH LAKES BLVD STE 206
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3413
Country	:	US
Telephone Number	:	561-841-6960
Fax Number	:

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

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	11/26/2019

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