Basic Information
| Provider Information | |||||||||
| NPI: | 1427389188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKOWSKY | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 400 | ||||||||
| Address2: | |||||||||
| City: | COTOPAXI | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812230400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192855121 | ||||||||
| FaxNumber: | 7192189994 | ||||||||
| Practice Location | |||||||||
| Address1: | 7481 W. OAKLAND PARK BLVD. | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LAUDERHILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333194985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058914228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | ARNP9202664 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 001845100 | 05 | FL | MEDICAID |