Provider Demographics
NPI:1568820579
Name:BURKE CONSULTING CORPORATION
Entity Type:Organization
Organization Name:BURKE CONSULTING CORPORATION
Other - Org Name:GRANNY NANNIES OF TAMPA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-870-7234
Mailing Address - Street 1:3381 MAGIC OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1821
Mailing Address - Country:US
Mailing Address - Phone:941-870-7234
Mailing Address - Fax:
Practice Address - Street 1:2836 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6744
Practice Address - Country:US
Practice Address - Phone:727-894-2922
Practice Address - Fax:727-894-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211066251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017329200Medicaid