Healthcare Provider Details

I. General information

NPI: 1407903008
Provider Name (Legal Business Name): JENNIFER GLORIOSO RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 W FIREOPAL WAY
TUCSON AZ
85742-9429
US

IV. Provider business mailing address

5280 W FIREOPAL WAY
TUCSON AZ
85742-9429
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-7625
  • Fax:
Mailing address:
  • Phone: 520-744-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN129968
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: