Provider Demographics
NPI:1316449978
Name:BURDICK, CLIFFORD PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:PAUL
Last Name:BURDICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 NE 12TH TER APT 31
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4601
Mailing Address - Country:US
Mailing Address - Phone:401-248-4307
Mailing Address - Fax:
Practice Address - Street 1:5150 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6543
Practice Address - Country:US
Practice Address - Phone:561-498-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9327466367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered