Provider Demographics
NPI:1952354599
Name:BURTNER, BARBARA ANN (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:BURTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 FRANKLIN DR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4022
Mailing Address - Country:US
Mailing Address - Phone:321-724-1614
Mailing Address - Fax:321-722-3590
Practice Address - Street 1:2123 FRANKLIN DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4022
Practice Address - Country:US
Practice Address - Phone:321-724-1614
Practice Address - Fax:321-722-3590
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME729752084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45056OtherBCBS
49450OtherAM BD OF PSYCH & NEUROL
FL253216600Medicaid
DCXB5347883OtherDEA LICENSE
FL253216600Medicaid
FL45056OtherBCBS
FL253216600Medicaid