Provider Demographics
NPI:1235654054
Name:BURNS, TANDRA F (BA)
Entity Type:Individual
Prefix:
First Name:TANDRA
Middle Name:F
Last Name:BURNS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0043
Mailing Address - Country:US
Mailing Address - Phone:850-348-3166
Mailing Address - Fax:
Practice Address - Street 1:212 W HIGHWAY 98 STE C
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1301
Practice Address - Country:US
Practice Address - Phone:850-705-1766
Practice Address - Fax:850-705-1766
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator