Healthcare Provider Details

I. General information

NPI: 1316068166
Provider Name (Legal Business Name): DEBORAH A BURKE MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 CLEARWATER LARGO RD N
LARGO FL
33770-2335
US

IV. Provider business mailing address

2810 W SAINT ISABEL ST SUITE 201
TAMPA FL
33607-6375
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-8777
  • Fax: 727-584-8772
Mailing address:
  • Phone: 727-585-7020
  • Fax: 727-518-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME78541
License Number StateFL

VIII. Authorized Official

Name: DR. DEBORAH A BURKE
Title or Position: OWNER
Credential: MD
Phone: 727-452-4084