Provider Demographics
NPI:1356390785
Name:BURKE, CHRISTINA M (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:BURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4440 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1926
Mailing Address - Country:US
Mailing Address - Phone:941-366-0134
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:3251 3RD AVE N RM 125
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8549
Practice Address - Country:US
Practice Address - Phone:727-498-4969
Practice Address - Fax:855-896-5258
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106379363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019988400Medicaid
FL292426900Medicaid
AL51534143Medicare ID - Type Unspecified
MS09013231Medicaid
AL51534146OtherBCBS SPRINGHILL
AL009936711Medicaid
FL292426900Medicaid
AL51534143OtherBCBS FILLINGIM
Q12655Medicare UPIN