Provider Demographics
NPI:1932407897
Name:BURKEYBILE, ALYSON ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:ANNE
Last Name:BURKEYBILE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:ANNE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:787 CORTARO DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6812
Mailing Address - Country:US
Mailing Address - Phone:813-634-2500
Mailing Address - Fax:813-634-3008
Practice Address - Street 1:787 CORTARO DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-634-2500
Practice Address - Fax:813-634-3008
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005757363A00000X
FLPA9112392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1045253300Medicaid