Provider Demographics
NPI:1922452812
Name:BURGINS, SHELLEY LYNNE (ARNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNNE
Last Name:BURGINS
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 1:720 REDFIN DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3902
Mailing Address - Country:US
Mailing Address - Phone:864-634-0533
Mailing Address - Fax:
Practice Address - Street 1:720 REDFIN DR
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3902
Practice Address - Country:US
Practice Address - Phone:864-634-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1052622363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health