Provider Demographics
NPI:1922265396
Name:BURGIN, KIMBERLY EDWARDS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:EDWARDS
Last Name:BURGIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 CAPPER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5140
Mailing Address - Country:US
Mailing Address - Phone:904-864-6672
Mailing Address - Fax:
Practice Address - Street 1:2946 CAPPER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5140
Practice Address - Country:US
Practice Address - Phone:904-864-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5170473164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6935214 96Medicaid