Provider Demographics
NPI:1528555786
Name:BURGESS, JANELLE (MPH)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 GATE PKWY STE 104-323
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2893
Mailing Address - Country:US
Mailing Address - Phone:850-254-5028
Mailing Address - Fax:
Practice Address - Street 1:7643 GATE PKWY STE 104-323
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2893
Practice Address - Country:US
Practice Address - Phone:850-254-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator