Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN9190307 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9190307 | FL |
NPI | 1003319732 |
---|---|
Provider Name | Jennifer Glisson |
First Address | Riverview, FL 33578-3800 |
Second Address | Riverview, FL 33578-3800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 25/11/2020 |