Provider Demographics
NPI:1497819577
Name:GABORKO, GLENN EARL JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:EARL
Last Name:GABORKO
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5159
Mailing Address - Country:US
Mailing Address - Phone:407-687-4577
Mailing Address - Fax:407-823-1611
Practice Address - Street 1:UNIVERSITY OF CENTRAL FLORIDA STUDENT HEALTH SERVICES
Practice Address - Street 2:BUILDING 127
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-0001
Practice Address - Country:US
Practice Address - Phone:407-823-1616
Practice Address - Fax:407-823-1611
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical