MEDICARE: JESSICA BURGAN

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	363L00000X	Nurse Practitioner	APRN11001137	FL

General Provider Information

NPI Number	:	1508320458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BURGAN

Provider Business Mailing Address
First Line	:	2047 HIGH RIDGE DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1311
Country	:	US
Telephone Number	:	727-612-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	2047 HIGH RIDGE DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1311
Country	:	US
Telephone Number	:	727-612-6637
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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