Provider Demographics
NPI:1548343387
Name:BURGESS, JANICE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:BURGESS
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 1:9400 SPARTA HWY
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-7282
Mailing Address - Country:US
Mailing Address - Phone:931-277-5992
Mailing Address - Fax:931-277-5996
Practice Address - Street 1:4015 HIGHWOOD DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3101
Practice Address - Country:US
Practice Address - Phone:423-451-7623
Practice Address - Fax:423-451-7677
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14438OtherLICENSE
TN280155OtherAMERICAN NURSES CREDENTIALING CENTER CERTIFICATION
14438OtherLICENSE
280155OtherAMERICAN NURSES CREDENTIALING CENTER CERTIFICATION