Provider Demographics
NPI:1649338815
Name:BURDIN, DANIEL BRADLEY (RN, FNP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRADLEY
Last Name:BURDIN
Suffix:
Gender:M
Credentials:RN, FNP
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:BRAD
Other - Last Name:BURDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, DACNB
Mailing Address - Street 1:9502 COMPUTER DR
Mailing Address - Street 2:STE. 200A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2382
Mailing Address - Country:US
Mailing Address - Phone:210-690-6992
Mailing Address - Fax:210-690-6952
Practice Address - Street 1:9502 COMPUTER DR STE 200A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2383
Practice Address - Country:US
Practice Address - Phone:210-690-6992
Practice Address - Fax:210-690-6952
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6933111NN0400X
TX781475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX644411ZGVZOtherMEDICARE
TX8A7046OtherBLUE CROSS BLUE SHIELD