MEDICARE: MS. CHERYL PLOTKIN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 2202	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y03PV	OTHER	FL	BC BS
3	7720498	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1851388672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL PLOTKIN PA

Provider Business Mailing Address
First Line	:	7015 AC SKINNER PARKWAY
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-538-3672

Provider Business Practice Location Address
First Line	:	2 SHIRCLIFF WAY
Second Line	:	SUITE 800
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4753
Country	:	US
Telephone Number	:	904-388-2619
Fax Number	:	904-388-0240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	06/07/2013

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