Provider Demographics
NPI:1760663983
Name:BURTON, VIRGINIA ANNE (MSN, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ANNE
Last Name:BURTON
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICKNAME
Mailing Address - Street 1:1223 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2607
Mailing Address - Country:US
Mailing Address - Phone:321-242-8790
Mailing Address - Fax:321-242-1541
Practice Address - Street 1:7125 MURRELL RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-242-8790
Practice Address - Fax:321-242-1541
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3251692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP33559Medicare UPIN
FLE5668ZMedicare PIN