Provider Demographics
NPI:1144739137
Name:BURDICK, LESLI (CAA)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:
Last Name:BURDICK
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:
Other - Last Name:BURDICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAA
Mailing Address - Street 1:800 MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-955-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22355902367H00000X
FLAA422367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant