Provider Demographics
NPI:1851506760
Name:PARKER, CINDY R (DHSC, PA-C)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:R
Last Name:PARKER
Suffix:
Gender:F
Credentials:DHSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 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:386-213-9186
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:386-317-2000
Practice Address - Fax:386-265-5552
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101534500Medicaid
FLPA3248OtherSTATE LICENSE
FLPA3248OtherSTATE LICENSE