MEDICARE: SHANNON GLINKA

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1982236428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GLINKA

Provider Business Mailing Address
First Line	:	1005 SENECIO PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 SENECIO PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4467
Country	:	US
Telephone Number	:	904-230-2125
Fax Number	:

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

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	05/25/2023

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Directions to “ SHANNON GLINKA ” Practice Location

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