Provider Demographics
NPI:1912568494
Name:BURGIN, COURTNEY VANCE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VANCE
Last Name:BURGIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CRYSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TN
Mailing Address - Zip Code:37727-2757
Mailing Address - Country:US
Mailing Address - Phone:828-467-0645
Mailing Address - Fax:
Practice Address - Street 1:1829 CROWE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7264
Practice Address - Country:US
Practice Address - Phone:423-623-0653
Practice Address - Fax:423-625-8264
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily