Provider Demographics
NPI:1578952875
Name:BURKE, PATRICK MATHIAS
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MATHIAS
Last Name:BURKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7196 N PLUM TREE UNIT 311
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-1119
Mailing Address - Country:US
Mailing Address - Phone:941-456-1791
Mailing Address - Fax:
Practice Address - Street 1:7196 N PLUM TREE UNIT 311
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-1119
Practice Address - Country:US
Practice Address - Phone:941-456-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-10
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9248645163W00000X
FLARNP9248645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse