Provider Demographics
NPI:1891389672
Name:BURBANK, TROY (PA-C)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:BURBANK
Suffix:
Gender:M
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 1:2820 GEORGE WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-0630
Mailing Address - Country:US
Mailing Address - Phone:863-397-3220
Mailing Address - Fax:
Practice Address - Street 1:1830 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-4713
Practice Address - Country:US
Practice Address - Phone:352-463-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical