Individual provider Active NPI

Cynthia A Demola, PA

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1720020167
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00094400 Issued in NJ
Practice address
4123 University Blvd S Ste E
Jacksonville, FL 32216-4320
Phone
(904) 744-4448
Fax
(904) 744-4048
NPI assigned
Jun 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00094400 NJ Primary
Physician Assistant 363A00000X PA9116747 FL

Addresses

Primary practice location

4123 University Blvd S Ste E
Jacksonville, FL 32216-4320

Mailing address

4123 University Blvd S Ste E
Jacksonville, FL 32216-4320
Phone (904) 744-4448

Other names 1

  • Ms. Cynthia A Demola Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260310003135 FL Practitioner - Physician Assistant 7214918168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1275 Matengo Cir
St Johns, FL 32259-8009

7825 Baymeadows Way
Suite 104a
Jacksonville, FL 32256-7535

PO Box
Suite 57189
Jacksonville, FL 32241-7189

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9116747FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
First Coast Nephrology Inc CurrentSince Mar 4, 2026 Accepting new patients
Essex Kidney Group, LLC PastSince Feb 9, 2009 Accepting new patients
The Kidney Group PA Past Accepting new patients

Locations

4123 University Blvd S
Ste E
Jacksonville, FL 32216
Phone (904) 737-2722

1594 Kingsley Ave
Orange Park, FL 32073
Phone (904) 264-8621

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1720020167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4123 UNIVERSITY BLVD S STE E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164320",
            "telephone_number": "904-744-4448",
            "fax_number": "904-744-4048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 UNIVERSITY BLVD S STE E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164320",
            "telephone_number": "904-744-4448",
            "fax_number": "904-744-4048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMOLA",
        "first_name": "CYNTHIA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00094400",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116747",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "DEMOLA",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.