Provider Demographics
NPI:1588125298
Name:BURGESS, APRIL BULLOCK (APRN)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:BULLOCK
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BEACON WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3094
Mailing Address - Country:US
Mailing Address - Phone:228-547-1645
Mailing Address - Fax:
Practice Address - Street 1:137 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5063
Practice Address - Country:US
Practice Address - Phone:850-833-7500
Practice Address - Fax:850-833-7528
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001943363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health