Provider Demographics
NPI:1639691108
Name:GLACKIN, DARBY CHRISTIANA (ATC)
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:CHRISTIANA
Last Name:GLACKIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85166 CHERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3779
Mailing Address - Country:US
Mailing Address - Phone:845-803-1158
Mailing Address - Fax:
Practice Address - Street 1:1045 RIVERSIDE AVE STE 190
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4189
Practice Address - Country:US
Practice Address - Phone:904-647-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer