Healthcare Provider Details

I. General information

NPI: 1114784022
Provider Name (Legal Business Name): LINA GLEBOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 HILLCREST DR APT 118
HOLLYWOOD FL
33021-7931
US

IV. Provider business mailing address

4400 HILLCREST DR APT 118
HOLLYWOOD FL
33021-7931
US

V. Phone/Fax

Practice location:
  • Phone: 754-213-9728
  • Fax:
Mailing address:
  • Phone: 754-213-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11029769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11029769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: