Provider Demographics
NPI:1073055042
Name:BURDEN, LATESHA KANSHAY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LATESHA
Middle Name:KANSHAY
Last Name:BURDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17703 PARKWAY GREEN LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2530
Mailing Address - Country:US
Mailing Address - Phone:561-261-1512
Mailing Address - Fax:
Practice Address - Street 1:17703 PARKWAY GREEN LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2530
Practice Address - Country:US
Practice Address - Phone:561-261-1512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner