Healthcare Provider Details

I. General information

NPI: 1487824728
Provider Name (Legal Business Name): GLORIA KOO REID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 2069
JACKSONVILLE FL
32216-1471
US

IV. Provider business mailing address

4205 BELFORT RD STE 2069
JACKSONVILLE FL
32216-1471
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-8500
  • Fax:
Mailing address:
  • Phone: 904-450-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR168950
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: