Provider Demographics
NPI:1851388672
Name:PLOTKIN, CHERYL (PA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:PLOTKIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 AC SKINNER PARKWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-388-2619
Practice Address - Fax:904-388-0240
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2202363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290477200Medicaid
FLY03PVOtherBC BS
FL7720498OtherAETNA
FLE5030WMedicare PIN
FLY03PVOtherBC BS
FLE5030YMedicare PIN
FLE5030VMedicare PIN
FLQ21853Medicare UPIN
FLP00286387Medicare PIN