Provider Demographics
NPI:1699504944
Name:BURKE, JODI ANN (FNP)
Entity type:Individual
Prefix:
First Name:JODI ANN
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 AGASTIA CT UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3077
Mailing Address - Country:US
Mailing Address - Phone:786-925-2501
Mailing Address - Fax:
Practice Address - Street 1:15516 W COLONIAL DR STE 111
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9558
Practice Address - Country:US
Practice Address - Phone:407-530-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner