Healthcare Provider Details

I. General information

NPI: 1811215858
Provider Name (Legal Business Name): GLORYIAN D. EWING LMT, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6859 LENOX AVE STE 4
JACKSONVILLE FL
32205-6149
US

IV. Provider business mailing address

8407 HERLONG RD
JACKSONVILLE FL
32210-2327
US

V. Phone/Fax

Practice location:
  • Phone: 904-575-5531
  • Fax:
Mailing address:
  • Phone: 904-382-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA102448
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 5178499
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA44439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: