Shelley Lynne Burgins, ARNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Atlantic Beach, FL
NPI 1922452812 · NPPES record last updated Apr 18, 2016
Key facts
- NPI
- 1922452812
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 1052622 (FL)
- Practice address
- 720 Redfin Dr
Atlantic Beach, FL 32233-3902 - Phone
- (864) 634-0533
- NPI assigned
- Apr 18, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- TBJ Behavioral Center LLC
Practice addresses (Care Compare)
6300 Beach Blvd
Jacksonville, FL 32216-2708
Phone (904) 724-9202
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170425001676 | FL | Practitioner - Nurse Practitioner | 1850678046 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1052622 | FL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TBJ Behavioral Center LLC | Current |
Accepting new patients |
Locations
6300 Beach Blvd
Jacksonville, FL 32216
Phone (904) 724-9202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1052622 | FL | Yes |
Addresses
Primary practice location
720 Redfin Dr
Atlantic Beach, FL 32233-3902
Mailing address
720 Redfin Dr
Atlantic Beach, FL 32233-3902
Phone (864) 634-0533
Other providers in Atlantic Beach, FL
- Meghan Braun
- Eric T. Broe
- Meredith Nancy Broner
- Charlene Bryson
- Elena Burch
- Maegan Burns
- Elizabeth Ann Byrnes
- Ingrid Carlson
- Kelly Charest
- Carol Chiang
All providers in Atlantic Beach, FL · Psychiatric/Mental Health Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.