Healthcare Provider Details

I. General information

NPI: 1730845942
Provider Name (Legal Business Name): JHEANELLE R GLEVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JHEANELLE R SHEPHERD

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E GEORGIA ST
BARTOW FL
33830-6710
US

IV. Provider business mailing address

2055 E GEORGIA ST
BARTOW FL
33830-6710
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-0578
  • Fax:
Mailing address:
  • Phone: 863-533-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: