Provider Demographics
NPI:1851613335
Name:BURNEY, JUSTIN C (CRNA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:BURNEY
Suffix:
Gender:M
Credentials:CRNA
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 491529
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1529
Mailing Address - Country:US
Mailing Address - Phone:352-209-4019
Mailing Address - Fax:866-339-1813
Practice Address - Street 1:1329 SW 16TH ST ROOM 2232
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5925
Practice Address - Country:US
Practice Address - Phone:352-733-0485
Practice Address - Fax:352-265-8077
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213982367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001995900Medicaid