MEDICARE: MRS. CONNIE 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	363LW0102X	Women's Health Nurse Practitioner	APRN11031859	FL

General Provider Information

NPI Number	:	1932941770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE BURKE

Provider Business Mailing Address
First Line	:	3021 TIPPERARY DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2770 CAPITAL MEDICAL BLVD STE 220
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8417
Country	:	US
Telephone Number	:	850-391-3880
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/12/2024

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Directions to “ MRS. CONNIE BURKE ” Practice Location

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