Healthcare Provider Details

I. General information

NPI: 1497678247
Provider Name (Legal Business Name): LISA GLAVIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11405 28TH STREET CIR E
PARRISH FL
34219-8986
US

IV. Provider business mailing address

11405 28TH STREET CIR E
PARRISH FL
34219-8986
US

V. Phone/Fax

Practice location:
  • Phone: 941-526-7059
  • Fax:
Mailing address:
  • Phone: 941-526-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2497972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: