Healthcare Provider Details

I. General information

NPI: 1811539042
Provider Name (Legal Business Name): JOSEPH BURKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 STATE ROAD 70 E
BRADENTON FL
34203-9712
US

IV. Provider business mailing address

1115 E TWIGGS ST UNIT 1102
TAMPA FL
33602-3179
US

V. Phone/Fax

Practice location:
  • Phone: 941-755-4242
  • Fax: 941-755-1906
Mailing address:
  • Phone: 708-476-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: