Individual
TATIANA BURROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
291 MILL ST W, JACKSONVILLE, FL 32234-1307
(916) 804-8657
Mailing address
6282 AUTUMN BERRY CIR, JACKSONVILLE, FL 32258-8413
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4276
FL
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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