1467930446 NPI number — CONEKIA MARSHEA BURGESS MSN RN APRN FNP-C

Table of content: CONEKIA MARSHEA BURGESS MSN RN APRN FNP-C (NPI 1467930446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467930446 NPI number — CONEKIA MARSHEA BURGESS MSN RN APRN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGESS
Provider First Name:
CONEKIA
Provider Middle Name:
MARSHEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN RN APRN FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KINSEY
Provider Other First Name:
CONEKIA
Provider Other Middle Name:
MARSHEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN RN FNP-C CRRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467930446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5191 FIRST COAST TECH PKWY FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32224-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-223-3321
Provider Business Mailing Address Fax Number:
904-223-2169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 PARK ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-223-3321
Provider Business Practice Location Address Fax Number:
904-223-2169
Provider Enumeration Date:
08/01/2018

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: 363LF0000X , with the licence number:  F06180161 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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