Individual
JESSICA BURGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
466 SW PORT ST LUCIE BLVD STE 114, PORT ST LUCIE, FL 34953-2091
(772) 837-0500
(772) 264-7903
Mailing address
466 SW PORT ST LUCIE BLVD STE 114, PORT ST LUCIE, FL 34953-2091
(772) 837-0500
(772) 264-7903
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041403333
IL
163W00000X
Registered Nurse
Primary
RN9562775
FL
163WH0200X
Home Health Registered Nurse
736
FL
163WI0500X
Infusion Therapy Registered Nurse
777
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2300231
CLIA WAIVER
FL
01
—
6029027
HEALTH CARE CLINIC ESTABLISHMENT
FL
Enumeration date
01/22/2021
Last updated
08/03/2024
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