Healthcare Provider Details

I. General information

NPI: 1659871762
Provider Name (Legal Business Name): HALEY DANAE GLASSER DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY DANAE REID DNP, FNP-C

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 209
JACKSONVILLE FL
32258-5233
US

IV. Provider business mailing address

2054 RIVERSIDE AVE APT 5108
JACKSONVILLE FL
32204-4447
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5437
  • Fax:
Mailing address:
  • Phone: 678-763-8139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN260216
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN260216
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: