Provider Demographics
NPI:1316991383
Name:BURKETT, WARREN L (PA-C)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:L
Last Name:BURKETT
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 1:206 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1042
Mailing Address - Country:US
Mailing Address - Phone:941-746-5111
Mailing Address - Fax:941-745-7206
Practice Address - Street 1:14050 NW 14TH ST
Practice Address - Street 2:SUITE 190
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2865
Practice Address - Country:US
Practice Address - Phone:800-424-3672
Practice Address - Fax:954-377-3042
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP43720Medicare UPIN
FLE64674Medicare ID - Type Unspecified