Healthcare Provider Details

I. General information

NPI: 1396910998
Provider Name (Legal Business Name): GLADYS M VARGAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

PO BOX 732901
DALLAS TX
75373-2901
US

V. Phone/Fax

Practice location:
  • Phone: 386-254-4080
  • Fax: 386-947-1764
Mailing address:
  • Phone: 386-226-4590
  • Fax: 386-226-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP 1926242
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP 1926242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: