Provider Demographics
NPI:1679669402
Name:BURKE, BARBARA B (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:BURKE
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 1:5867 BENEVENTO DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2879
Mailing Address - Country:US
Mailing Address - Phone:859-608-3300
Mailing Address - Fax:
Practice Address - Street 1:516 VENEZIA PKWY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-237-0222
Practice Address - Fax:208-330-2458
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9108555363A00000X
FLPA9108555363AM0700X
KYPA429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP
KY970017966OtherRAILROAD MEDICARE PIN
KYCB5773OtherRAILROAD MEDICARE GROUP
KY36000818OtherMEDICAID GROUP ASC
KYASC1019OtherASC MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
KY95004297Medicaid
S70311Medicare UPIN
KY95004297Medicaid