Provider Demographics
NPI:1962413021
Name:GLOTZBACH, DAFFENY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:DAFFENY
Middle Name:LYNN
Last Name:GLOTZBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAFFENY
Other - Middle Name:LYNN
Other - Last Name:IGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7960 S UNIVERSITY BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3167
Mailing Address - Country:US
Mailing Address - Phone:303-716-8018
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:200 W. COUNTY LINE RD.
Practice Address - Street 2:STE #130
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:303-791-0418
Practice Address - Fax:303-791-1849
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant