Provider Demographics
NPI:1831573096
Name:BURGESS, LAURA JEANNE (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEANNE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BERGLUND LN STE B
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6230
Mailing Address - Country:US
Mailing Address - Phone:321-610-8955
Mailing Address - Fax:321-610-8954
Practice Address - Street 1:1715 BERGLUND LN STE B
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6230
Practice Address - Country:US
Practice Address - Phone:321-610-8955
Practice Address - Fax:321-610-8954
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3414042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily