Provider Demographics
NPI:1407470768
Name:PARKER INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:PARKER INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, PA-C
Authorized Official - Phone:386-316-2525
Mailing Address - Street 1:1367 BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1529
Mailing Address - Country:US
Mailing Address - Phone:386-316-2525
Mailing Address - Fax:903-213-9186
Practice Address - Street 1:1367 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1529
Practice Address - Country:US
Practice Address - Phone:386-316-2525
Practice Address - Fax:903-213-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty