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1134779812
MALLORY BURKE
LAKELAND, FL
NPI
1134779812
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Former Name
MALLORY BASTIAN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: FL PA9112457)
Enumeration Date
2019-09-16
Last Update Date
2024-05-08
Business Address
Ms. MALLORY BURKE PA
1600 LAKELAND HILLS BLVD
LAKELAND, FL 33805-3065
Phone number: 863-680-7214
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Mailing Address
Ms. MALLORY BURKE PA
5422 BAYSHORE BLVD
TAMPA, FL 33611-4122
Phone number:
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