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NPI Code Detail

MEDICARE: MRS. THERESA MARIE GLOSTER CRNA

MEDICARE:  MRS. THERESA MARIE GLOSTER  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN573951PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G00AROTHERFLBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467783886
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA MARIE GLOSTER CRNA
Provider Business Mailing Address
First Line : 3130 ATWATER DR
Second Line :
City : NORTH PORT
State : FL
Zip : 34288-8302
Country : US
Telephone Number : 814-421-8945
Fax Number :
Provider Business Practice Location Address
First Line : 3130 ATWATER DR
Second Line :
City : NORTH PORT
State : FL
Zip : 34288-8302
Country : US
Telephone Number : 814-421-8945
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2010
Last Update Date : 06/03/2013

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