Provider Demographics
NPI:1316214638
Name:TOMLIN, LYNNETTE GLASSCHO (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:GLASSCHO
Last Name:TOMLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:FATIMA
Other - Last Name:GLASSCHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2475 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1820
Mailing Address - Country:US
Mailing Address - Phone:803-778-6555
Mailing Address - Fax:
Practice Address - Street 1:2475 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1820
Practice Address - Country:US
Practice Address - Phone:803-778-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7124OtherMEDICARE NUMBER
SC1304Medicaid