Healthcare Provider Details

I. General information

NPI: 1013503572
Provider Name (Legal Business Name): DEVON GLYNN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8606 GOVERNMENT DR STE 3
NEW PORT RICHEY FL
34654-5510
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2277
US

V. Phone/Fax

Practice location:
  • Phone: 727-816-1520
  • Fax:
Mailing address:
  • Phone: 303-814-0505
  • Fax: 720-638-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036444
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996129-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: