Provider Demographics
NPI:1346225174
Name:BURNSIDE, JANET GAY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:GAY
Last Name:BURNSIDE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9818 W PARK VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5139
Mailing Address - Country:US
Mailing Address - Phone:813-476-4637
Mailing Address - Fax:813-792-5369
Practice Address - Street 1:18167 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 650
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3528
Practice Address - Country:US
Practice Address - Phone:727-437-3530
Practice Address - Fax:727-498-1159
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP923043367500000X
MO080642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235126921OtherRAILROAD MEDICARE PART B GROUP NPI
MODG0204OtherRAILROAD MEDICARE PART B GROUP PTAN
MO1346225174OtherRAILROAD MEDICARE PART B GROUP MEMBER NPI
MOP00620222OtherRAILROAD MEDICARE PART B GROUP MEMBER PTAN
ILK037474Medicare ID - Type Unspecified