Basic Information
| Provider Information | |||||||||
| NPI: | 1063754455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURDEINICK | ||||||||
| FirstName: | ISAAC | ||||||||
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| Credential: | SA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 W END AVE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455400 | ||||||||
| FaxNumber: | 8884686511 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SARNO RD | ||||||||
| Address2: | SUITE 15 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329354938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003484565 | ||||||||
| FaxNumber: | 8884686511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2013 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9544171 | FL | N | Nursing Service Providers | Registered Nurse | 246ZC0007X | ABSA 12-191 | FL | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 363L00000X | APRN11020794 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.