Provider Demographics
NPI:1255688727
Name:BURGMAN, JAMIE ANN (BA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:BURGMAN
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 1:1010 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3529
Mailing Address - Country:US
Mailing Address - Phone:321-281-3840
Mailing Address - Fax:866-936-8124
Practice Address - Street 1:1010 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3529
Practice Address - Country:US
Practice Address - Phone:321-281-3840
Practice Address - Fax:866-936-8124
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator