Provider Demographics
NPI:1346064003
Name:BURNETT-TURNER, TYRA LOUISE
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:LOUISE
Last Name:BURNETT-TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3766 NW 202ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1433
Mailing Address - Country:US
Mailing Address - Phone:786-862-2045
Mailing Address - Fax:
Practice Address - Street 1:3766 NW 202ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1433
Practice Address - Country:US
Practice Address - Phone:786-862-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier