Provider Demographics
NPI:1649230301
Name:BURCHIANTI, TEENA MARIA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TEENA
Middle Name:MARIA
Last Name:BURCHIANTI
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:PO BOX 116304
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6304
Mailing Address - Country:US
Mailing Address - Phone:904-588-1800
Mailing Address - Fax:904-588-1300
Practice Address - Street 1:2015 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3531
Practice Address - Country:US
Practice Address - Phone:904-588-1800
Practice Address - Fax:904-588-1300
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2743102363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA326712903AMedicaid
FL3052699-00Medicaid
FLP00045944Medicare PIN
GA326712903AMedicaid
FL3052699-00Medicaid