Provider Demographics
NPI:1588112155
Name:CASTENIR, GLORIA ASHLEY (PA-C)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ASHLEY
Last Name:CASTENIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ASHLEY
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:455 PINELLAS ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-446-2273
Practice Address - Fax:727-441-4966
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019253400Medicaid
FLIU500ZMedicare PIN