Individual
KRYSTA-GAYE LATOYA BURCHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 SW ARCHER RD, GAINESVILLE, FL 32608-1134
(352) 265-0111
Mailing address
3403 FOXCROFT RD, MIRAMAR, FL 33025-4186
(954) 445-7871
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 9108009
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012891300
—
FL
Enumeration date
07/17/2014
Last updated
10/20/2014
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