Provider Demographics
NPI:1396014270
Name:BURCHETT, GLORIA A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:A
Last Name:BURCHETT
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 1:1111 CARVELL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2725
Mailing Address - Country:US
Mailing Address - Phone:407-620-2437
Mailing Address - Fax:
Practice Address - Street 1:1111 CARVELL DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-620-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM64538363L00000X
NY308043363LA2200X
OR201207068NP-P363LA2200X
ME161170363LA2200X
FLARNP2800082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner