Healthcare Provider Details

I. General information

NPI: 1457629149
Provider Name (Legal Business Name): GLORIA PICART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 S WILLIAMSON BLVD STE # 774
PORT ORANGE FL
32128-8311
US

IV. Provider business mailing address

2121 SW LEAFY RD
PORT ST LUCIE FL
34953-1362
US

V. Phone/Fax

Practice location:
  • Phone: 866-426-2811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 9179037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: