Healthcare Provider Details

I. General information

NPI: 1992525695
Provider Name (Legal Business Name): GLENDA SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 DOREEN DR
LAKELAND FL
33810-2922
US

IV. Provider business mailing address

3811 SE 9TH PL
OCALA FL
34471-4865
US

V. Phone/Fax

Practice location:
  • Phone: 863-553-8974
  • Fax:
Mailing address:
  • Phone: 863-553-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: