MEDICARE: MS. PATRICIA BURKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1912391442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA BURKE

Provider Business Mailing Address
First Line	:	2004 NW 37TH BLVD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-3636
Country	:	US
Telephone Number	:	352-872-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 NW 37TH BLVD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-3636
Country	:	US
Telephone Number	:	352-273-8555
Fax Number	:	352-294-8088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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