Healthcare Provider Details

I. General information

NPI: 1669609038
Provider Name (Legal Business Name): KRISTINE GLOVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5413 GEORGE ST
NEW PORT RICHEY FL
34652-4101
US

IV. Provider business mailing address

5413 GEORGE ST
NEW PORT RICHEY FL
34652-4101
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-7618
  • Fax: 727-849-7090
Mailing address:
  • Phone: 727-846-7618
  • Fax: 727-849-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9175501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: