Provider Demographics
NPI:1386844322
Name:BURRES, ROBYN IVY (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:IVY
Last Name:BURRES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3625
Mailing Address - Country:US
Mailing Address - Phone:561-737-8376
Mailing Address - Fax:
Practice Address - Street 1:715 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3625
Practice Address - Country:US
Practice Address - Phone:561-737-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000E6602ZMedicare UPIN