Healthcare Provider Details

I. General information

NPI: 1851388672
Provider Name (Legal Business Name): CHERYL PLOTKIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHIRCLIFF WAY SUITE 800
JACKSONVILLE FL
32204-4753
US

IV. Provider business mailing address

7015 AC SKINNER PARKWAY SUITE 1
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-2619
  • Fax: 904-388-0240
Mailing address:
  • Phone: 904-363-2113
  • Fax: 904-538-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 2202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: