1972705739 NPI number — DR. JAMIE PATRICIA BURROWS D.O.

Table of content: DANIEL J RANDLE AS, CAPRC2 (NPI 1497212328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972705739 NPI number — DR. JAMIE PATRICIA BURROWS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURROWS
Provider First Name:
JAMIE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972705739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 W MILLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-842-3775
Provider Business Mailing Address Fax Number:
407-648-9879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 CYPRESS GLEN CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-7560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-518-1074
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  0102201840 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: OS12014 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 207V00000Y . This is a "TAXONOMY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200579000A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: OS12014 . This is a "FL MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1972705739 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200579000B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009769400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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