Provider Demographics
NPI:1033683685
Name:BURTON, LORREKA RAKIYA (CPE)
Entity Type:Individual
Prefix:
First Name:LORREKA
Middle Name:RAKIYA
Last Name:BURTON
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 32ND AVE S APT 4
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-7724
Mailing Address - Country:US
Mailing Address - Phone:678-927-1446
Mailing Address - Fax:
Practice Address - Street 1:600 32ND AVE S APT 4
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-7724
Practice Address - Country:US
Practice Address - Phone:678-927-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4052172V00000X, 174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator