Healthcare Provider Details

I. General information

NPI: 1912491382
Provider Name (Legal Business Name): HALIMEH GLOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 JUSTIN LAKE DR
JACKSONVILLE FL
32221-3850
US

IV. Provider business mailing address

2228 JUSTIN LAKE DR
JACKSONVILLE FL
32221-3850
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-8812
  • Fax:
Mailing address:
  • Phone: 904-679-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9500778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: