Provider Demographics
NPI:1710223649
Name:GLADFELTER, JANE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:GLADFELTER
Suffix:
Gender:F
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 1:1800 S EGRET BAY BLVD
Mailing Address - Street 2:APT 8107
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1420
Mailing Address - Country:US
Mailing Address - Phone:202-450-0026
Mailing Address - Fax:
Practice Address - Street 1:10950 RESOURCE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6158
Practice Address - Country:US
Practice Address - Phone:281-484-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical