Provider Demographics
NPI:1255500492
Name:PARK BURDON, DEBRA M (RT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:PARK BURDON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 CAROLINE RIDGE LN N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-9310
Mailing Address - Country:US
Mailing Address - Phone:904-745-9303
Mailing Address - Fax:
Practice Address - Street 1:9126 CAROLINE RIDGE LN N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-9310
Practice Address - Country:US
Practice Address - Phone:904-745-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 1400227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified