Provider Demographics
NPI:1376575696
Name:BURGUNDER, PATRICIA MARIE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:MARIE
Last Name:BURGUNDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W BROADWAY ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9260
Mailing Address - Country:US
Mailing Address - Phone:407-706-1650
Mailing Address - Fax:407-706-1651
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-706-1650
Practice Address - Fax:407-706-1651
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2148302363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2148302OtherARNP NUMBER