Healthcare Provider Details

I. General information

NPI: 1720020167
Provider Name (Legal Business Name): CYNTHIA A DEMOLA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA A DEMOLA PA-C

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 UNIVERSITY BLVD S STE E
JACKSONVILLE FL
32216-4320
US

IV. Provider business mailing address

4123 UNIVERSITY BLVD S STE E
JACKSONVILLE FL
32216-4320
US

V. Phone/Fax

Practice location:
  • Phone: 904-744-4448
  • Fax: 904-744-4048
Mailing address:
  • Phone: 904-744-4448
  • Fax: 904-744-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00094400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: