Healthcare Provider Details

I. General information

NPI: 1508169699
Provider Name (Legal Business Name): GLENDA HANNAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLENDA MACIEL-HANNAN

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE
HOLLYWOOD FL
33021-5424
US

IV. Provider business mailing address

1150 N 35TH AVE
HOLLYWOOD FL
33021-5424
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-1125
  • Fax:
Mailing address:
  • Phone: 954-265-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARN9275654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: