Individual
TINA L BURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
100 JOHN ROEMMELT DR, SUITE 301, HORSEHEADS, NY 14845-8301
(607) 739-0352
(607) 739-6909
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
307665-1
NY
363LA2200X
Adult Health Nurse Practitioner
F300557-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01276246
—
NY
Enumeration date
01/08/2007
Last updated
09/13/2016
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