Provider Demographics
NPI:1245278563
Name:BURNS, JOLITA CELINE (MD)
Entity type:Individual
Prefix:DR
First Name:JOLITA
Middle Name:CELINE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1885 PROFESSIONAL PARK CIR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4572
Mailing Address - Country:US
Mailing Address - Phone:850-656-0302
Mailing Address - Fax:850-656-6110
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8417
Practice Address - Country:US
Practice Address - Phone:850-877-5589
Practice Address - Fax:850-942-5793
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340397100Medicaid
GA81058Medicare ID - Type Unspecified
GAF85591Medicare UPIN