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General NPI Number Information
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NPI Number | 1992856801
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Entity Type | Individual
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Provider Name | JEREMY J BURKETT PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 2605 WELAUNEE BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4697
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Country | US
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Telephone | 850-877-8174
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Fax | 844-261-6839
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Provider Business Mailing Address
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Address Line | 3334 CAPITAL MEDICAL BLVD STE 400
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4470
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Country | US
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Telephone | 850-877-8174
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Fax | 844-261-6839
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117615
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License Number State | FL
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