Provider Demographics
NPI:1366899825
Name:BURR, SERENA (CPM, LM)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:BURR
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S NOVA RD STE R
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7362
Mailing Address - Country:US
Mailing Address - Phone:386-227-7663
Mailing Address - Fax:386-204-7117
Practice Address - Street 1:800 S NOVA RD STE R
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7362
Practice Address - Country:US
Practice Address - Phone:386-227-7663
Practice Address - Fax:386-204-7117
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FLMW329176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101854800Medicaid