Healthcare Provider Details

I. General information

NPI: 1922436922
Provider Name (Legal Business Name): MAKEBA JOY BURKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ELM ST STE 204
MANCHESTER NH
03101-1844
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 954-412-1960
  • Fax: 603-933-7105
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: