Provider Demographics
NPI:1154580462
Name:GLASSICK, CINDY HOLSTON (PA-C)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:HOLSTON
Last Name:GLASSICK
Suffix:
Gender:F
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 1:1186 EASTWOOD BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-1803
Mailing Address - Country:US
Mailing Address - Phone:904-287-0136
Mailing Address - Fax:
Practice Address - Street 1:4901 RICHARD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7328
Practice Address - Country:US
Practice Address - Phone:904-237-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical