=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477382992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIAN LANOR GLASSMAN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2024
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15255 MAX LEGGET PKWY STE 5100
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32218-7274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-541-0315
-----------------------------------------------------
Fax | 904-541-0316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160295
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32716-0295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-458-1303
-----------------------------------------------------
Fax | 904-541-0316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9119015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------