Provider Demographics
NPI:1871239723
Name:BURKE, CARLY NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:NICOLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MAITLAND CENTER PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7442
Mailing Address - Country:US
Mailing Address - Phone:407-426-4800
Mailing Address - Fax:407-426-4820
Practice Address - Street 1:2400 MAITLAND CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7442
Practice Address - Country:US
Practice Address - Phone:407-426-4800
Practice Address - Fax:407-426-4820
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily